{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.35,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.35,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.35,"endTime":14.49,"body":"Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":14.81,"endTime":16.58,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.81,"endTime":16.58,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.58,"endTime":19.67,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.58,"endTime":19.67,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.67,"endTime":21.5,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.67,"endTime":21.5,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.07,"endTime":24.35,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.07,"endTime":24.35,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.35,"endTime":25.25,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.46,"endTime":27.68,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.46,"endTime":27.68,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.68,"endTime":28.25,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":29.06,"endTime":30.05,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":29.06,"endTime":30.05,"body":"Chris."},{"speaker":"Chris Dy","startTime":30.2,"endTime":32.27,"body":"Hey, Chuck. That's a"},{"speaker":"Chris Dy","startTime":30.2,"endTime":32.27,"body":"little low energy from you over"},{"speaker":"Chris Dy","startTime":32.27,"endTime":32.96,"body":"there. What's going on?"},{"speaker":"Charles Goldfarb","startTime":32.99,"endTime":35.3,"body":"No, plenty of"},{"speaker":"Charles Goldfarb","startTime":32.99,"endTime":35.3,"body":"energy. I was going deep, deep."},{"speaker":"Chris Dy","startTime":37.46,"endTime":39.35,"body":"How's it how's your"},{"speaker":"Chris Dy","startTime":37.46,"endTime":39.35,"body":"morning, been? We're recording"},{"speaker":"Chris Dy","startTime":39.35,"endTime":40.43,"body":"on a Saturday morning."},{"speaker":"Charles Goldfarb","startTime":40.83,"endTime":42.87,"body":"You know, my"},{"speaker":"Charles Goldfarb","startTime":40.83,"endTime":42.87,"body":"morning has been pretty good. I"},{"speaker":"Charles Goldfarb","startTime":42.87,"endTime":47.61,"body":"had a long week a lot going on."},{"speaker":"Charles Goldfarb","startTime":42.87,"endTime":47.61,"body":"And I woke up I do I get up"},{"speaker":"Charles Goldfarb","startTime":47.61,"endTime":51.39,"body":"early, despite my best"},{"speaker":"Charles Goldfarb","startTime":47.61,"endTime":51.39,"body":"intentions and got some work"},{"speaker":"Charles Goldfarb","startTime":51.39,"endTime":53.94,"body":"done. And then I was just"},{"speaker":"Charles Goldfarb","startTime":51.39,"endTime":53.94,"body":"sitting in reading and having a"},{"speaker":"Charles Goldfarb","startTime":54.0,"endTime":56.1,"body":"delightful morning and then I"},{"speaker":"Charles Goldfarb","startTime":54.0,"endTime":56.1,"body":"got the text."},{"speaker":"Chris Dy","startTime":56.19,"endTime":58.95,"body":"Okay, so what does a"},{"speaker":"Chris Dy","startTime":56.19,"endTime":58.95,"body":"weekend of work look like for"},{"speaker":"Chris Dy","startTime":58.95,"endTime":60.93,"body":"you? Like what kind of work are"},{"speaker":"Chris Dy","startTime":58.95,"endTime":60.93,"body":"you knocking out on the"},{"speaker":"Chris Dy","startTime":60.93,"endTime":61.47,"body":"weekends?"},{"speaker":"Charles Goldfarb","startTime":62.32,"endTime":65.53,"body":"It's usually a"},{"speaker":"Charles Goldfarb","startTime":62.32,"endTime":65.53,"body":"combo I try to make it a combo."},{"speaker":"Charles Goldfarb","startTime":65.53,"endTime":69.16,"body":"It's not clinical. I you know,"},{"speaker":"Charles Goldfarb","startTime":65.53,"endTime":69.16,"body":"my thing is, I don't like to"},{"speaker":"Charles Goldfarb","startTime":69.16,"endTime":72.28,"body":"leave any particular day without"},{"speaker":"Charles Goldfarb","startTime":69.16,"endTime":72.28,"body":"clinical work done. That means"},{"speaker":"Charles Goldfarb","startTime":72.28,"endTime":76.3,"body":"all dictations all phone calls"},{"speaker":"Charles Goldfarb","startTime":72.28,"endTime":76.3,"body":"all MRI reviews. So I'm pretty"},{"speaker":"Charles Goldfarb","startTime":76.3,"endTime":80.71,"body":"good about that. And then"},{"speaker":"Charles Goldfarb","startTime":76.3,"endTime":80.71,"body":"weekends are for admin, mainly."},{"speaker":"Charles Goldfarb","startTime":82.09,"endTime":85.24,"body":"department work, I guess I"},{"speaker":"Charles Goldfarb","startTime":82.09,"endTime":85.24,"body":"should say and, but also"},{"speaker":"Charles Goldfarb","startTime":85.24,"endTime":88.63,"body":"research, I feel. I don't like"},{"speaker":"Charles Goldfarb","startTime":85.24,"endTime":88.63,"body":"it if it gets tilted too much"},{"speaker":"Charles Goldfarb","startTime":88.63,"endTime":91.54,"body":"toward administrative work, and"},{"speaker":"Charles Goldfarb","startTime":88.63,"endTime":91.54,"body":"not enough research work. So"},{"speaker":"Charles Goldfarb","startTime":91.54,"endTime":94.21,"body":"it's usually a combo. Okay, what"},{"speaker":"Charles Goldfarb","startTime":91.54,"endTime":94.21,"body":"about you?"},{"speaker":"Chris Dy","startTime":95.23,"endTime":98.26,"body":"Well, so we just"},{"speaker":"Chris Dy","startTime":95.23,"endTime":98.26,"body":"finished doing our annual"},{"speaker":"Chris Dy","startTime":98.32,"endTime":102.79,"body":"cadaver, brachial plexus lab and"},{"speaker":"Chris Dy","startTime":98.32,"endTime":102.79,"body":"peripheral nerve lab. You know,"},{"speaker":"Chris Dy","startTime":102.79,"endTime":104.95,"body":"the folks at Axogen were kind"},{"speaker":"Chris Dy","startTime":102.79,"endTime":104.95,"body":"enough to bring in a guest"},{"speaker":"Chris Dy","startTime":104.95,"endTime":109.12,"body":"speaker. And since I think"},{"speaker":"Chris Dy","startTime":104.95,"endTime":109.12,"body":"probably last five years, we've"},{"speaker":"Chris Dy","startTime":109.12,"endTime":113.2,"body":"actually taken this as an"},{"speaker":"Chris Dy","startTime":109.12,"endTime":113.2,"body":"opportunity to bring in a torso"},{"speaker":"Chris Dy","startTime":113.2,"endTime":117.25,"body":"specimen and today's case, a"},{"speaker":"Chris Dy","startTime":113.2,"endTime":117.25,"body":"whole body specimen, which we're"},{"speaker":"Chris Dy","startTime":117.25,"endTime":121.51,"body":"incredibly grateful for, because"},{"speaker":"Chris Dy","startTime":117.25,"endTime":121.51,"body":"the opportunity to do dissection"},{"speaker":"Chris Dy","startTime":121.51,"endTime":123.91,"body":"around the neck and fully around"},{"speaker":"Chris Dy","startTime":121.51,"endTime":123.91,"body":"the shoulder without the"},{"speaker":"Chris Dy","startTime":123.91,"endTime":127.48,"body":"shoulder being disarticulated is"},{"speaker":"Chris Dy","startTime":123.91,"endTime":127.48,"body":"really helpful because those are"},{"speaker":"Chris Dy","startTime":127.48,"endTime":130.54,"body":"all the nooks and crannies of"},{"speaker":"Chris Dy","startTime":127.48,"endTime":130.54,"body":"the anatomy that are very tough"},{"speaker":"Chris Dy","startTime":130.54,"endTime":133.72,"body":"to get at otherwise, that for"},{"speaker":"Chris Dy","startTime":130.54,"endTime":133.72,"body":"obvious reasons. It's very"},{"speaker":"Chris Dy","startTime":133.99,"endTime":136.48,"body":"difficult to secure those"},{"speaker":"Chris Dy","startTime":133.99,"endTime":136.48,"body":"specimens. So we had a great"},{"speaker":"Chris Dy","startTime":136.48,"endTime":137.53,"body":"time in the lab this morning."},{"speaker":"Charles Goldfarb","startTime":137.96,"endTime":140.9,"body":"So you"},{"speaker":"Charles Goldfarb","startTime":137.96,"endTime":140.9,"body":"dissected obviously both sides,"},{"speaker":"Charles Goldfarb","startTime":140.93,"endTime":145.97,"body":"big Plexus dissection. Wow,"},{"speaker":"Charles Goldfarb","startTime":140.93,"endTime":145.97,"body":"that's awesome. And it was you"},{"speaker":"Charles Goldfarb","startTime":145.97,"endTime":147.95,"body":"I'm guessing Brogan and our"},{"speaker":"Charles Goldfarb","startTime":145.97,"endTime":147.95,"body":"three fellows."},{"speaker":"Chris Dy","startTime":148.04,"endTime":150.35,"body":"Yeah, yeah. So one of"},{"speaker":"Chris Dy","startTime":148.04,"endTime":150.35,"body":"our fellows couldn't make it."},{"speaker":"Chris Dy","startTime":150.38,"endTime":153.32,"body":"Had a family emergency. But"},{"speaker":"Chris Dy","startTime":150.38,"endTime":153.32,"body":"otherwise, yeah, we had a great"},{"speaker":"Chris Dy","startTime":153.32,"endTime":155.87,"body":"time. And several of our"},{"speaker":"Chris Dy","startTime":153.32,"endTime":155.87,"body":"residents came and they were"},{"speaker":"Chris Dy","startTime":155.87,"endTime":159.59,"body":"working on the working on"},{"speaker":"Chris Dy","startTime":155.87,"endTime":159.59,"body":"extremity specimens, and one of"},{"speaker":"Chris Dy","startTime":159.59,"endTime":163.13,"body":"our hand therapists came. So it"},{"speaker":"Chris Dy","startTime":159.59,"endTime":163.13,"body":"was just a fun time. And, you"},{"speaker":"Chris Dy","startTime":163.13,"endTime":166.22,"body":"know, it was interesting shout"},{"speaker":"Chris Dy","startTime":163.13,"endTime":166.22,"body":"out to Jamie Findeiss who does a"},{"speaker":"Chris Dy","startTime":166.22,"endTime":168.35,"body":"lot of our brachial plexus"},{"speaker":"Chris Dy","startTime":166.22,"endTime":168.35,"body":"therapy and she works with"},{"speaker":"Chris Dy","startTime":168.35,"endTime":172.64,"body":"Athletico. And she took it on"},{"speaker":"Chris Dy","startTime":168.35,"endTime":172.64,"body":"her, you know, she took the"},{"speaker":"Chris Dy","startTime":172.64,"endTime":175.82,"body":"initiative and came into the"},{"speaker":"Chris Dy","startTime":172.64,"endTime":175.82,"body":"lab. And, you know, we actually"},{"speaker":"Chris Dy","startTime":175.82,"endTime":179.33,"body":"did a free function and gracilis"},{"speaker":"Chris Dy","startTime":175.82,"endTime":179.33,"body":"of sorts, David harvested the"},{"speaker":"Chris Dy","startTime":179.36,"endTime":183.38,"body":"gracilis, I inset it in there."},{"speaker":"Chris Dy","startTime":179.36,"endTime":183.38,"body":"And then she's has a newer"},{"speaker":"Chris Dy","startTime":183.38,"endTime":185.69,"body":"appreciation for the surgery,"},{"speaker":"Chris Dy","startTime":183.38,"endTime":185.69,"body":"which was really cool that she"},{"speaker":"Chris Dy","startTime":185.69,"endTime":187.22,"body":"came into the lab and hung out"},{"speaker":"Chris Dy","startTime":185.69,"endTime":187.22,"body":"with us."},{"speaker":"Charles Goldfarb","startTime":187.73,"endTime":190.7,"body":"You know, cool"},{"speaker":"Charles Goldfarb","startTime":187.73,"endTime":190.7,"body":"on many levels that first of all"},{"speaker":"Charles Goldfarb","startTime":190.73,"endTime":194.39,"body":"labs like that are priceless."},{"speaker":"Charles Goldfarb","startTime":190.73,"endTime":194.39,"body":"And I'm sure I know, you already"},{"speaker":"Charles Goldfarb","startTime":194.39,"endTime":197.27,"body":"said you appreciate it. I know"},{"speaker":"Charles Goldfarb","startTime":194.39,"endTime":197.27,"body":"our trainees did as well. And"},{"speaker":"Charles Goldfarb","startTime":197.27,"endTime":199.91,"body":"Jamie as well. And that's the"},{"speaker":"Charles Goldfarb","startTime":197.27,"endTime":199.91,"body":"second part is having great"},{"speaker":"Charles Goldfarb","startTime":199.91,"endTime":203.12,"body":"therapy partners, we've said"},{"speaker":"Charles Goldfarb","startTime":199.91,"endTime":203.12,"body":"over and over and over is"},{"speaker":"Charles Goldfarb","startTime":203.12,"endTime":205.01,"body":"priceless. And yet another"},{"speaker":"Charles Goldfarb","startTime":203.12,"endTime":205.01,"body":"demonstration."},{"speaker":"Chris Dy","startTime":205.64,"endTime":210.05,"body":"Yeah, and we were"},{"speaker":"Chris Dy","startTime":205.64,"endTime":210.05,"body":"we've been rehabbing, more nerve"},{"speaker":"Chris Dy","startTime":210.05,"endTime":212.63,"body":"transfer patients together. And"},{"speaker":"Chris Dy","startTime":210.05,"endTime":212.63,"body":"you know, I showed her some of"},{"speaker":"Chris Dy","startTime":212.63,"endTime":215.06,"body":"the nerve transfers that we were"},{"speaker":"Chris Dy","startTime":212.63,"endTime":215.06,"body":"doing for radial nerve palsy."},{"speaker":"Chris Dy","startTime":215.54,"endTime":219.38,"body":"And I think just seeing having"},{"speaker":"Chris Dy","startTime":215.54,"endTime":219.38,"body":"her see the anatomy is super"},{"speaker":"Chris Dy","startTime":219.38,"endTime":223.94,"body":"useful. And just fun all around."},{"speaker":"Chris Dy","startTime":219.38,"endTime":223.94,"body":"So yes, it was a wonderful lab."},{"speaker":"Chris Dy","startTime":224.03,"endTime":226.1,"body":"And I hear that you've been in"},{"speaker":"Chris Dy","startTime":224.03,"endTime":226.1,"body":"the labs who recently?"},{"speaker":"Charles Goldfarb","startTime":226.82,"endTime":229.76,"body":"I have you"},{"speaker":"Charles Goldfarb","startTime":226.82,"endTime":229.76,"body":"know, I don't do you know, big"},{"speaker":"Charles Goldfarb","startTime":229.76,"endTime":234.71,"body":"brachial plexus work. But I am"},{"speaker":"Charles Goldfarb","startTime":229.76,"endTime":234.71,"body":"intrigued by a new in this"},{"speaker":"Charles Goldfarb","startTime":234.71,"endTime":238.49,"body":"topic, carpal tunnel tool,"},{"speaker":"Charles Goldfarb","startTime":234.71,"endTime":238.49,"body":"called the carpal clip, that"},{"speaker":"Charles Goldfarb","startTime":238.61,"endTime":241.22,"body":"friend of mine helped develop"},{"speaker":"Charles Goldfarb","startTime":238.61,"endTime":241.22,"body":"and I've been wanting to try it"},{"speaker":"Charles Goldfarb","startTime":241.22,"endTime":246.11,"body":"and I have to say, I walked away"},{"speaker":"Charles Goldfarb","startTime":241.22,"endTime":246.11,"body":"impressed, did five cadavers. It"},{"speaker":"Charles Goldfarb","startTime":246.11,"endTime":250.04,"body":"was quick, it felt incredibly"},{"speaker":"Charles Goldfarb","startTime":246.11,"endTime":250.04,"body":"safe. Visualization was"},{"speaker":"Charles Goldfarb","startTime":250.04,"endTime":253.88,"body":"excellent. So next step will"},{"speaker":"Charles Goldfarb","startTime":250.04,"endTime":253.88,"body":"probably be the setup a few of"},{"speaker":"Charles Goldfarb","startTime":253.88,"endTime":257.27,"body":"these on patients. I give full"},{"speaker":"Charles Goldfarb","startTime":253.88,"endTime":257.27,"body":"disclosure in these situations"},{"speaker":"Charles Goldfarb","startTime":257.27,"endTime":261.41,"body":"to the patient. Pros Cons my"},{"speaker":"Charles Goldfarb","startTime":257.27,"endTime":261.41,"body":"experience and probably do a"},{"speaker":"Charles Goldfarb","startTime":261.41,"endTime":265.46,"body":"couple more cadavers you know,"},{"speaker":"Charles Goldfarb","startTime":261.41,"endTime":265.46,"body":"right before and give this thing"},{"speaker":"Charles Goldfarb","startTime":265.46,"endTime":267.95,"body":"a shot. It really is quite nice."},{"speaker":"Chris Dy","startTime":268.52,"endTime":270.44,"body":"It's interesting. You"},{"speaker":"Chris Dy","startTime":268.52,"endTime":270.44,"body":"say that because I am also in"},{"speaker":"Chris Dy","startTime":270.44,"endTime":275.0,"body":"the midst of trying a new type"},{"speaker":"Chris Dy","startTime":270.44,"endTime":275.0,"body":"of carpal tunnel release"},{"speaker":"Chris Dy","startTime":275.0,"endTime":280.04,"body":"technique. And it's using"},{"speaker":"Chris Dy","startTime":275.0,"endTime":280.04,"body":"ultrasound guidance. And so I"},{"speaker":"Chris Dy","startTime":280.07,"endTime":284.39,"body":"have done two labs now have a"},{"speaker":"Chris Dy","startTime":280.07,"endTime":284.39,"body":"third lab scheduled and just"},{"speaker":"Chris Dy","startTime":284.39,"endTime":286.64,"body":"trying to get more reps with the"},{"speaker":"Chris Dy","startTime":284.39,"endTime":286.64,"body":"ultrasound and using that"},{"speaker":"Chris Dy","startTime":286.64,"endTime":288.83,"body":"guidance. And it's interesting,"},{"speaker":"Chris Dy","startTime":286.64,"endTime":288.83,"body":"I think next week, we're gonna"},{"speaker":"Chris Dy","startTime":288.83,"endTime":291.05,"body":"have a discussion about you"},{"speaker":"Chris Dy","startTime":288.83,"endTime":291.05,"body":"know, the What's New In Hand"},{"speaker":"Chris Dy","startTime":291.05,"endTime":295.16,"body":"surgery article and it includes"},{"speaker":"Chris Dy","startTime":291.05,"endTime":295.16,"body":"some discussion about endoscopic"},{"speaker":"Chris Dy","startTime":295.16,"endTime":299.48,"body":"versus open and the pros and"},{"speaker":"Chris Dy","startTime":295.16,"endTime":299.48,"body":"cons. But yes, of course,"},{"speaker":"Chris Dy","startTime":299.51,"endTime":301.7,"body":"obviously Making sure that we"},{"speaker":"Chris Dy","startTime":299.51,"endTime":301.7,"body":"feel comfortable with the new"},{"speaker":"Chris Dy","startTime":301.7,"endTime":304.46,"body":"techniques, disclosing it to"},{"speaker":"Chris Dy","startTime":301.7,"endTime":304.46,"body":"patients, the pros, the cons,"},{"speaker":"Chris Dy","startTime":304.88,"endTime":306.95,"body":"and then seeing where it goes"},{"speaker":"Chris Dy","startTime":304.88,"endTime":306.95,"body":"from there. I don't I'm not I"},{"speaker":"Chris Dy","startTime":306.95,"endTime":310.13,"body":"don't know for sure if I'm going"},{"speaker":"Chris Dy","startTime":306.95,"endTime":310.13,"body":"to, to use it. I obviously have"},{"speaker":"Chris Dy","startTime":310.13,"endTime":313.04,"body":"to feel comfortable before I"},{"speaker":"Chris Dy","startTime":310.13,"endTime":313.04,"body":"make that decision."},{"speaker":"Charles Goldfarb","startTime":313.37,"endTime":316.73,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":313.37,"endTime":316.73,"body":"absolutely. We have to be 100%"},{"speaker":"Charles Goldfarb","startTime":316.73,"endTime":320.63,"body":"comfortable and there's an"},{"speaker":"Charles Goldfarb","startTime":316.73,"endTime":320.63,"body":"absolute requirement to be"},{"speaker":"Charles Goldfarb","startTime":320.63,"endTime":323.24,"body":"upper, you know, to be"},{"speaker":"Charles Goldfarb","startTime":320.63,"endTime":323.24,"body":"forthright with our patients"},{"speaker":"Charles Goldfarb","startTime":323.24,"endTime":327.29,"body":"about this process. So we should"},{"speaker":"Charles Goldfarb","startTime":323.24,"endTime":327.29,"body":"both report back and whatever it"},{"speaker":"Charles Goldfarb","startTime":327.29,"endTime":331.31,"body":"is three months or something"},{"speaker":"Charles Goldfarb","startTime":327.29,"endTime":331.31,"body":"like that and share how what if"},{"speaker":"Charles Goldfarb","startTime":331.31,"endTime":332.09,"body":"anything has happened?"},{"speaker":"Chris Dy","startTime":332.57,"endTime":335.03,"body":"For sure. So what are"},{"speaker":"Chris Dy","startTime":332.57,"endTime":335.03,"body":"we talking about today?"},{"speaker":"Charles Goldfarb","startTime":335.93,"endTime":338.87,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":335.93,"endTime":338.87,"body":"keep hearing whispers that we"},{"speaker":"Charles Goldfarb","startTime":338.87,"endTime":340.43,"body":"need more sports."},{"speaker":"Chris Dy","startTime":340.61,"endTime":342.98,"body":"Especially after last"},{"speaker":"Chris Dy","startTime":340.61,"endTime":342.98,"body":"week's congenital episode."},{"speaker":"Charles Goldfarb","startTime":343.97,"endTime":345.74,"body":"And I agree we"},{"speaker":"Charles Goldfarb","startTime":343.97,"endTime":345.74,"body":"need more sports."},{"speaker":"Chris Dy","startTime":345.74,"endTime":347.87,"body":"Gotta come back strong"},{"speaker":"Chris Dy","startTime":345.74,"endTime":347.87,"body":"and get people going again."},{"speaker":"Charles Goldfarb","startTime":348.269,"endTime":351.839,"body":"So you know"},{"speaker":"Charles Goldfarb","startTime":348.269,"endTime":351.839,"body":"what, despite of a lockout,"},{"speaker":"Charles Goldfarb","startTime":351.989,"endTime":355.109,"body":"baseball is hopefully around the"},{"speaker":"Charles Goldfarb","startTime":351.989,"endTime":355.109,"body":"corner let's let's talk about"},{"speaker":"Charles Goldfarb","startTime":355.109,"endTime":358.739,"body":"some basic baseball injuries"},{"speaker":"Charles Goldfarb","startTime":355.109,"endTime":358.739,"body":"and, and concepts around them."},{"speaker":"Charles Goldfarb","startTime":358.739,"endTime":359.309,"body":"What do you think?"},{"speaker":"Chris Dy","startTime":359.55,"endTime":362.07,"body":"Well, I think so. Cuz"},{"speaker":"Chris Dy","startTime":359.55,"endTime":362.07,"body":"I mean, St. Louis is a baseball"},{"speaker":"Chris Dy","startTime":362.07,"endTime":365.34,"body":"and hockey town now. You know,"},{"speaker":"Chris Dy","startTime":362.07,"endTime":365.34,"body":"we're recording this the weekend"},{"speaker":"Chris Dy","startTime":365.34,"endTime":367.8,"body":"of the Super Bowl. And I"},{"speaker":"Chris Dy","startTime":365.34,"endTime":367.8,"body":"guarantee you, there are very"},{"speaker":"Chris Dy","startTime":367.8,"endTime":369.9,"body":"few people in St. Louis cheering"},{"speaker":"Chris Dy","startTime":367.8,"endTime":369.9,"body":"for the Rams."},{"speaker":"Charles Goldfarb","startTime":370.23,"endTime":372.0,"body":"That that is"},{"speaker":"Charles Goldfarb","startTime":370.23,"endTime":372.0,"body":"right. My eyes. The whole"},{"speaker":"Charles Goldfarb","startTime":372.0,"endTime":374.85,"body":"playoffs. All I've been about is"},{"speaker":"Charles Goldfarb","startTime":372.0,"endTime":374.85,"body":"that the Rams not make the Super"},{"speaker":"Charles Goldfarb","startTime":374.85,"endTime":377.94,"body":"Bowl. So one thing's for sure."},{"speaker":"Charles Goldfarb","startTime":374.85,"endTime":377.94,"body":"I'm cheering for Cincinnati."},{"speaker":"Charles Goldfarb","startTime":378.39,"endTime":381.69,"body":"This weekend? No, yeah, no"},{"speaker":"Charles Goldfarb","startTime":378.39,"endTime":381.69,"body":"doubt. But I would add one thing"},{"speaker":"Charles Goldfarb","startTime":381.69,"endTime":385.38,"body":"to what you said we are about to"},{"speaker":"Charles Goldfarb","startTime":381.69,"endTime":385.38,"body":"be a Major League Soccer city."},{"speaker":"Charles Goldfarb","startTime":385.95,"endTime":389.76,"body":"We were supposed to start in"},{"speaker":"Charles Goldfarb","startTime":385.95,"endTime":389.76,"body":"March of 2022. But because the"},{"speaker":"Charles Goldfarb","startTime":389.76,"endTime":394.23,"body":"pandemic got pushback, but the"},{"speaker":"Charles Goldfarb","startTime":389.76,"endTime":394.23,"body":"organization is awesome. And"},{"speaker":"Charles Goldfarb","startTime":394.26,"endTime":397.71,"body":"it's been been very enjoyable,"},{"speaker":"Charles Goldfarb","startTime":394.26,"endTime":397.71,"body":"interacting and kind of watching"},{"speaker":"Charles Goldfarb","startTime":397.71,"endTime":401.19,"body":"them grow. And so I'm looking"},{"speaker":"Charles Goldfarb","startTime":397.71,"endTime":401.19,"body":"forward to, to that, for sure."},{"speaker":"Chris Dy","startTime":401.9,"endTime":404.27,"body":"For everybody else,"},{"speaker":"Chris Dy","startTime":401.9,"endTime":404.27,"body":"we're recording this the weekend"},{"speaker":"Chris Dy","startTime":404.3,"endTime":407.39,"body":"of the Super Bowl. So Chuck, do"},{"speaker":"Chris Dy","startTime":404.3,"endTime":407.39,"body":"you have any predictions because"},{"speaker":"Chris Dy","startTime":407.39,"endTime":410.78,"body":"this episode's gonna drop after"},{"speaker":"Chris Dy","startTime":407.39,"endTime":410.78,"body":"the Super Bowl? So what's the"},{"speaker":"Chris Dy","startTime":410.78,"endTime":414.02,"body":"score gonna be? What's is how's"},{"speaker":"Chris Dy","startTime":410.78,"endTime":414.02,"body":"the halftime show? Gonna be?"},{"speaker":"Charles Goldfarb","startTime":414.92,"endTime":417.68,"body":"Yeah, it was a"},{"speaker":"Charles Goldfarb","startTime":414.92,"endTime":417.68,"body":"couple of remarkable things. One"},{"speaker":"Charles Goldfarb","startTime":417.68,"endTime":420.59,"body":"is just the gambling around the"},{"speaker":"Charles Goldfarb","startTime":417.68,"endTime":420.59,"body":"legalized gambling going on."},{"speaker":"Charles Goldfarb","startTime":420.59,"endTime":424.19,"body":"This is stunning. And as most of"},{"speaker":"Charles Goldfarb","startTime":420.59,"endTime":424.19,"body":"the listeners know, I don't"},{"speaker":"Charles Goldfarb","startTime":424.19,"endTime":428.69,"body":"personally have any experience"},{"speaker":"Charles Goldfarb","startTime":424.19,"endTime":428.69,"body":"you can wager on anything. The"},{"speaker":"Charles Goldfarb","startTime":428.69,"endTime":433.01,"body":"length of the national anthem to"},{"speaker":"Charles Goldfarb","startTime":428.69,"endTime":433.01,"body":"you know, anything you can think"},{"speaker":"Charles Goldfarb","startTime":433.01,"endTime":438.41,"body":"of the over under the first"},{"speaker":"Charles Goldfarb","startTime":433.01,"endTime":438.41,"body":"touchdown, everything. i I'll be"},{"speaker":"Charles Goldfarb","startTime":438.41,"endTime":441.98,"body":"honest, I don't follow the NFL"},{"speaker":"Charles Goldfarb","startTime":438.41,"endTime":441.98,"body":"as much as I follow college"},{"speaker":"Charles Goldfarb","startTime":441.98,"endTime":447.02,"body":"football, or the NBA. But I hope"},{"speaker":"Charles Goldfarb","startTime":441.98,"endTime":447.02,"body":"and I actually do believe"},{"speaker":"Charles Goldfarb","startTime":447.02,"endTime":449.15,"body":"Cincinnati is gonna win. Win by"},{"speaker":"Charles Goldfarb","startTime":447.02,"endTime":449.15,"body":"a touchdown."},{"speaker":"Chris Dy","startTime":449.57,"endTime":452.24,"body":"Okay, well, that's, I"},{"speaker":"Chris Dy","startTime":449.57,"endTime":452.24,"body":"mean, Cincinnati, you live there"},{"speaker":"Chris Dy","startTime":452.24,"endTime":455.96,"body":"for a year. So I, I'll give you"},{"speaker":"Chris Dy","startTime":452.24,"endTime":455.96,"body":"that. I would love it. If"},{"speaker":"Chris Dy","startTime":455.96,"endTime":458.69,"body":"Cincinnati won. I don't think"},{"speaker":"Chris Dy","startTime":455.96,"endTime":458.69,"body":"it's gonna happen. You know,"},{"speaker":"Chris Dy","startTime":458.69,"endTime":462.92,"body":"it's funny. I was writing what"},{"speaker":"Chris Dy","startTime":458.69,"endTime":462.92,"body":"the AFC Championship I was when"},{"speaker":"Chris Dy","startTime":462.92,"endTime":465.23,"body":"they were playing the Chiefs. I"},{"speaker":"Chris Dy","startTime":462.92,"endTime":465.23,"body":"was writing an email to the"},{"speaker":"Chris Dy","startTime":465.23,"endTime":469.04,"body":"group. And I jokingly said, you"},{"speaker":"Chris Dy","startTime":465.23,"endTime":469.04,"body":"know, when you're done watching"},{"speaker":"Chris Dy","startTime":469.04,"endTime":472.04,"body":"the Bengals come from behind"},{"speaker":"Chris Dy","startTime":469.04,"endTime":472.04,"body":"victory, take a look at this and"},{"speaker":"Chris Dy","startTime":472.04,"endTime":473.12,"body":"it actually came true."},{"speaker":"Charles Goldfarb","startTime":473.15,"endTime":474.98,"body":"Came true, I"},{"speaker":"Charles Goldfarb","startTime":473.15,"endTime":474.98,"body":"loved it, loved it."},{"speaker":"Chris Dy","startTime":476.45,"endTime":478.97,"body":"So I think the Rams"},{"speaker":"Chris Dy","startTime":476.45,"endTime":478.97,"body":"will pull it off, even though I"},{"speaker":"Chris Dy","startTime":478.97,"endTime":481.52,"body":"truly do not want them to. So"},{"speaker":"Chris Dy","startTime":478.97,"endTime":481.52,"body":"yeah, we'll see who was right."},{"speaker":"Chris Dy","startTime":481.55,"endTime":483.32,"body":"This episode will drop the"},{"speaker":"Chris Dy","startTime":481.55,"endTime":483.32,"body":"weekend after."},{"speaker":"Charles Goldfarb","startTime":483.92,"endTime":486.17,"body":"You're"},{"speaker":"Charles Goldfarb","startTime":483.92,"endTime":486.17,"body":"probably planning a feast of"},{"speaker":"Charles Goldfarb","startTime":486.17,"endTime":488.54,"body":"some sort for this event. If I"},{"speaker":"Charles Goldfarb","startTime":486.17,"endTime":488.54,"body":"know you."},{"speaker":"Chris Dy","startTime":488.69,"endTime":490.55,"body":"Oh, yeah, there's"},{"speaker":"Chris Dy","startTime":488.69,"endTime":490.55,"body":"gonna there's gonna be all the"},{"speaker":"Chris Dy","startTime":490.55,"endTime":494.75,"body":"things. And for better or worse,"},{"speaker":"Chris Dy","startTime":490.55,"endTime":494.75,"body":"I'll be preparing my waistline."},{"speaker":"Chris Dy","startTime":494.78,"endTime":500.09,"body":"So we'll see how it goes. So"},{"speaker":"Chris Dy","startTime":494.78,"endTime":500.09,"body":"yeah, baseball. So tell me. So"},{"speaker":"Chris Dy","startTime":500.09,"endTime":502.85,"body":"what are the most common? Like,"},{"speaker":"Chris Dy","startTime":500.09,"endTime":502.85,"body":"what are the three most common"},{"speaker":"Chris Dy","startTime":502.85,"endTime":506.6,"body":"hand injuries that occur with"},{"speaker":"Chris Dy","startTime":502.85,"endTime":506.6,"body":"baseball? And do you have to"},{"speaker":"Chris Dy","startTime":506.6,"endTime":509.54,"body":"distinguish, you know, batting"},{"speaker":"Chris Dy","startTime":506.6,"endTime":509.54,"body":"injuries versus pitching"},{"speaker":"Chris Dy","startTime":509.54,"endTime":511.46,"body":"injuries or throwing catching"},{"speaker":"Chris Dy","startTime":509.54,"endTime":511.46,"body":"that kind of thing?"},{"speaker":"Charles Goldfarb","startTime":512.33,"endTime":515.15,"body":"Yeah, you"},{"speaker":"Charles Goldfarb","startTime":512.33,"endTime":515.15,"body":"know, I think for this audience,"},{"speaker":"Charles Goldfarb","startTime":515.18,"endTime":517.31,"body":"and certainly we could dive"},{"speaker":"Charles Goldfarb","startTime":515.18,"endTime":517.31,"body":"deeper and we can even have a"},{"speaker":"Charles Goldfarb","startTime":517.31,"endTime":520.76,"body":"guest on which might be fun. You"},{"speaker":"Charles Goldfarb","startTime":517.31,"endTime":520.76,"body":"know, when we think about"},{"speaker":"Charles Goldfarb","startTime":520.76,"endTime":524.66,"body":"throwing injuries is"},{"speaker":"Charles Goldfarb","startTime":520.76,"endTime":524.66,"body":"predominantly pitchers obviously"},{"speaker":"Charles Goldfarb","startTime":524.66,"endTime":529.04,"body":"shortstops and third baseman"},{"speaker":"Charles Goldfarb","startTime":524.66,"endTime":529.04,"body":"getting can put a lot of torque"},{"speaker":"Charles Goldfarb","startTime":529.04,"endTime":530.66,"body":"on their arms. But obviously,"},{"speaker":"Charles Goldfarb","startTime":529.04,"endTime":530.66,"body":"we're talking about the"},{"speaker":"Charles Goldfarb","startTime":530.66,"endTime":534.8,"body":"repetition and the velocity of"},{"speaker":"Charles Goldfarb","startTime":530.66,"endTime":534.8,"body":"pitching, I vote, let's save"},{"speaker":"Charles Goldfarb","startTime":534.8,"endTime":538.25,"body":"that for another episode and"},{"speaker":"Charles Goldfarb","startTime":534.8,"endTime":538.25,"body":"have a guest on that can be fun,"},{"speaker":"Charles Goldfarb","startTime":538.46,"endTime":542.3,"body":"what might intrigue you is how"},{"speaker":"Charles Goldfarb","startTime":538.46,"endTime":542.3,"body":"often I'm addressing and maybe"},{"speaker":"Charles Goldfarb","startTime":542.3,"endTime":545.48,"body":"you are as well, but I work with"},{"speaker":"Charles Goldfarb","startTime":542.3,"endTime":545.48,"body":"our sports partners. And it's"},{"speaker":"Charles Goldfarb","startTime":545.48,"endTime":550.16,"body":"not uncommon that we work"},{"speaker":"Charles Goldfarb","startTime":545.48,"endTime":550.16,"body":"together on a medial elbow where"},{"speaker":"Charles Goldfarb","startTime":550.16,"endTime":554.21,"body":"the UCL is reconstructed, and"},{"speaker":"Charles Goldfarb","startTime":550.16,"endTime":554.21,"body":"the nerve is transposed. The"},{"speaker":"Charles Goldfarb","startTime":554.21,"endTime":557.57,"body":"goal, of course, is not to need"},{"speaker":"Charles Goldfarb","startTime":554.21,"endTime":557.57,"body":"to transpose the nerve. But if"},{"speaker":"Charles Goldfarb","startTime":557.57,"endTime":560.84,"body":"the nerve is irritable or"},{"speaker":"Charles Goldfarb","startTime":557.57,"endTime":560.84,"body":"unstable, then it in my mind is"},{"speaker":"Charles Goldfarb","startTime":560.84,"endTime":562.88,"body":"the right thing to do you have"},{"speaker":"Charles Goldfarb","startTime":560.84,"endTime":562.88,"body":"any thoughts on that?"},{"speaker":"Chris Dy","startTime":563.09,"endTime":567.38,"body":"Well, do you see, do"},{"speaker":"Chris Dy","startTime":563.09,"endTime":567.38,"body":"you see mechanical irritation of"},{"speaker":"Chris Dy","startTime":567.41,"endTime":571.43,"body":"the ulnar nerve in these"},{"speaker":"Chris Dy","startTime":567.41,"endTime":571.43,"body":"athletes with in the setting"},{"speaker":"Chris Dy","startTime":571.43,"endTime":575.69,"body":"where they don't have medial"},{"speaker":"Chris Dy","startTime":571.43,"endTime":575.69,"body":"ligamentous issues?"},{"speaker":"Charles Goldfarb","startTime":576.38,"endTime":579.44,"body":"Yes, and that"},{"speaker":"Charles Goldfarb","startTime":576.38,"endTime":579.44,"body":"is, especially in the adolescent"},{"speaker":"Charles Goldfarb","startTime":579.44,"endTime":584.06,"body":"population. And this is my"},{"speaker":"Charles Goldfarb","startTime":579.44,"endTime":584.06,"body":"theory. And you may have"},{"speaker":"Charles Goldfarb","startTime":584.06,"endTime":587.27,"body":"different thoughts on this. But"},{"speaker":"Charles Goldfarb","startTime":584.06,"endTime":587.27,"body":"my theory is that, you know, we"},{"speaker":"Charles Goldfarb","startTime":587.27,"endTime":589.94,"body":"think about a third of the"},{"speaker":"Charles Goldfarb","startTime":587.27,"endTime":589.94,"body":"population has older nerve"},{"speaker":"Charles Goldfarb","startTime":589.94,"endTime":594.35,"body":"instability. And we looked at"},{"speaker":"Charles Goldfarb","startTime":589.94,"endTime":594.35,"body":"that previously, and there's"},{"speaker":"Charles Goldfarb","startTime":594.35,"endTime":596.12,"body":"been some ultrasound studies on"},{"speaker":"Charles Goldfarb","startTime":594.35,"endTime":596.12,"body":"that as well, which are"},{"speaker":"Charles Goldfarb","startTime":596.12,"endTime":599.96,"body":"certainly more accurate than"},{"speaker":"Charles Goldfarb","startTime":596.12,"endTime":599.96,"body":"clinical exam studies. I believe"},{"speaker":"Charles Goldfarb","startTime":599.96,"endTime":603.41,"body":"What happens if for whatever"},{"speaker":"Charles Goldfarb","startTime":599.96,"endTime":603.41,"body":"reason the nerve gets irritable"},{"speaker":"Charles Goldfarb","startTime":604.16,"endTime":607.43,"body":"and if it is irritable and it is"},{"speaker":"Charles Goldfarb","startTime":604.16,"endTime":607.43,"body":"unstable, I do not find that"},{"speaker":"Charles Goldfarb","startTime":607.43,"endTime":612.11,"body":"those resolve very often. And so"},{"speaker":"Charles Goldfarb","startTime":607.43,"endTime":612.11,"body":"especially an athlete who is"},{"speaker":"Charles Goldfarb","startTime":612.11,"endTime":615.71,"body":"hesitant to take time off, to"},{"speaker":"Charles Goldfarb","startTime":612.11,"endTime":615.71,"body":"get it to calm down. So I think"},{"speaker":"Charles Goldfarb","startTime":615.71,"endTime":620.36,"body":"once it becomes stirred up even"},{"speaker":"Charles Goldfarb","startTime":615.71,"endTime":620.36,"body":"if the UCL is stable, addressing"},{"speaker":"Charles Goldfarb","startTime":620.36,"endTime":624.44,"body":"that owner becomes a priority if"},{"speaker":"Charles Goldfarb","startTime":620.36,"endTime":624.44,"body":"the need is to get back to play."},{"speaker":"Chris Dy","startTime":624.77,"endTime":627.86,"body":"How long and what kind"},{"speaker":"Chris Dy","startTime":624.77,"endTime":627.86,"body":"of non operative treatment will"},{"speaker":"Chris Dy","startTime":627.86,"endTime":630.32,"body":"you give them? Is this kind of"},{"speaker":"Chris Dy","startTime":627.86,"endTime":630.32,"body":"like going along lines of pitch"},{"speaker":"Chris Dy","startTime":630.32,"endTime":633.29,"body":"counts? Or is it night splinting"},{"speaker":"Chris Dy","startTime":630.32,"endTime":633.29,"body":"the normal stuff that we do."},{"speaker":"Charles Goldfarb","startTime":634.32,"endTime":637.53,"body":"If we're going"},{"speaker":"Charles Goldfarb","startTime":634.32,"endTime":637.53,"body":"to truly try to calm this down,"},{"speaker":"Charles Goldfarb","startTime":637.56,"endTime":643.77,"body":"it is an absolute no throw for"},{"speaker":"Charles Goldfarb","startTime":637.56,"endTime":643.77,"body":"six weeks, nighttime splint,"},{"speaker":"Charles Goldfarb","startTime":644.61,"endTime":649.77,"body":"daytime motion, but no throwing"},{"speaker":"Charles Goldfarb","startTime":644.61,"endTime":649.77,"body":"anti inflammatories, that's"},{"speaker":"Charles Goldfarb","startTime":649.77,"endTime":654.12,"body":"that's my, that's my regimen. If"},{"speaker":"Charles Goldfarb","startTime":649.77,"endTime":654.12,"body":"they are making progress into"},{"speaker":"Charles Goldfarb","startTime":654.12,"endTime":657.93,"body":"the six weeks, I will extend it"},{"speaker":"Charles Goldfarb","startTime":654.12,"endTime":657.93,"body":"for another six weeks and see"},{"speaker":"Charles Goldfarb","startTime":657.93,"endTime":660.66,"body":"what happens of course, now"},{"speaker":"Charles Goldfarb","startTime":657.93,"endTime":660.66,"body":"there's a big difference between"},{"speaker":"Charles Goldfarb","startTime":660.66,"endTime":663.6,"body":"reconstructing the UCL where"},{"speaker":"Charles Goldfarb","startTime":660.66,"endTime":663.6,"body":"you're looking at a year or"},{"speaker":"Charles Goldfarb","startTime":663.6,"endTime":667.53,"body":"more, and transposing ulnar"},{"speaker":"Charles Goldfarb","startTime":663.6,"endTime":667.53,"body":"nerve where honestly, by eight"},{"speaker":"Charles Goldfarb","startTime":667.53,"endTime":671.13,"body":"to 10 weeks, you can be back"},{"speaker":"Charles Goldfarb","startTime":667.53,"endTime":671.13,"body":"throwing full force. So I don't"},{"speaker":"Charles Goldfarb","startTime":671.13,"endTime":674.55,"body":"want to be knife happy by any"},{"speaker":"Charles Goldfarb","startTime":671.13,"endTime":674.55,"body":"stretch. But also in a high"},{"speaker":"Charles Goldfarb","startTime":674.55,"endTime":678.39,"body":"level athlete. I don't want to"},{"speaker":"Charles Goldfarb","startTime":674.55,"endTime":678.39,"body":"just immobilize way to mobilize"},{"speaker":"Charles Goldfarb","startTime":678.39,"endTime":681.03,"body":"weight when the reality may not"},{"speaker":"Charles Goldfarb","startTime":678.39,"endTime":681.03,"body":"be so positive."},{"speaker":"Chris Dy","startTime":681.39,"endTime":684.06,"body":"Do you see any role"},{"speaker":"Chris Dy","startTime":681.39,"endTime":684.06,"body":"for nerve studies or ultrasound"},{"speaker":"Chris Dy","startTime":684.06,"endTime":686.52,"body":"diagnostically in that"},{"speaker":"Chris Dy","startTime":684.06,"endTime":686.52,"body":"particular population?"},{"speaker":"Charles Goldfarb","startTime":687.02,"endTime":689.72,"body":"Absolutely not"},{"speaker":"Charles Goldfarb","startTime":687.02,"endTime":689.72,"body":"opposed to it? I don't believe"},{"speaker":"Charles Goldfarb","startTime":689.72,"endTime":692.66,"body":"it's always necessary or"},{"speaker":"Charles Goldfarb","startTime":689.72,"endTime":692.66,"body":"helpful, you know, an unstable"},{"speaker":"Charles Goldfarb","startTime":692.66,"endTime":696.11,"body":"nerve. Again, love to hear your"},{"speaker":"Charles Goldfarb","startTime":692.66,"endTime":696.11,"body":"more technical thoughts, and"},{"speaker":"Charles Goldfarb","startTime":696.11,"endTime":700.58,"body":"then stable nerve without hand"},{"speaker":"Charles Goldfarb","startTime":696.11,"endTime":700.58,"body":"based symptoms that is normal"},{"speaker":"Charles Goldfarb","startTime":700.58,"endTime":704.99,"body":"sensibility normal strength? I"},{"speaker":"Charles Goldfarb","startTime":700.58,"endTime":704.99,"body":"don't you know, it's unlikely to"},{"speaker":"Charles Goldfarb","startTime":704.99,"endTime":709.49,"body":"test positive based on the, you"},{"speaker":"Charles Goldfarb","startTime":704.99,"endTime":709.49,"body":"know, the basics of EMG and"},{"speaker":"Charles Goldfarb","startTime":709.49,"endTime":713.51,"body":"nerve conduction sensitivity. So"},{"speaker":"Charles Goldfarb","startTime":709.49,"endTime":713.51,"body":"I don't rush to do a nerve"},{"speaker":"Charles Goldfarb","startTime":713.51,"endTime":713.9,"body":"study."},{"speaker":"Chris Dy","startTime":714.29,"endTime":716.33,"body":"Yeah, I guess the way"},{"speaker":"Chris Dy","startTime":714.29,"endTime":716.33,"body":"I would think about is that if"},{"speaker":"Chris Dy","startTime":716.87,"endTime":720.89,"body":"it if it's going to change what"},{"speaker":"Chris Dy","startTime":716.87,"endTime":720.89,"body":"treatment I offer, then yes, I"},{"speaker":"Chris Dy","startTime":720.89,"endTime":724.1,"body":"would get it. And I would want"},{"speaker":"Chris Dy","startTime":720.89,"endTime":724.1,"body":"to know what your particular"},{"speaker":"Chris Dy","startTime":724.1,"endTime":727.7,"body":"transposition or maybe it's just"},{"speaker":"Chris Dy","startTime":724.1,"endTime":727.7,"body":"a decompression but what your"},{"speaker":"Chris Dy","startTime":727.7,"endTime":733.13,"body":"particular treatment would be."},{"speaker":"Chris Dy","startTime":727.7,"endTime":733.13,"body":"Because for me, if I would"},{"speaker":"Chris Dy","startTime":733.13,"endTime":736.01,"body":"probably still use my current"},{"speaker":"Chris Dy","startTime":733.13,"endTime":736.01,"body":"algorithm of an unstable"},{"speaker":"Chris Dy","startTime":736.01,"endTime":738.71,"body":"mechanical irritable nerve"},{"speaker":"Chris Dy","startTime":736.01,"endTime":738.71,"body":"without any signs of innovation"},{"speaker":"Chris Dy","startTime":738.71,"endTime":741.68,"body":"is going to get a subcutaneous"},{"speaker":"Chris Dy","startTime":738.71,"endTime":741.68,"body":"transposition with a nice added"},{"speaker":"Chris Dy","startTime":741.68,"endTime":745.55,"body":"professional fat pad flap kind"},{"speaker":"Chris Dy","startTime":741.68,"endTime":745.55,"body":"of transposition like the guys"},{"speaker":"Chris Dy","startTime":745.55,"endTime":750.98,"body":"from Colombia described. Its"},{"speaker":"Chris Dy","startTime":745.55,"endTime":750.98,"body":"signs of deactivation, and"},{"speaker":"Chris Dy","startTime":750.98,"endTime":753.44,"body":"anything in more advanced on the"},{"speaker":"Chris Dy","startTime":750.98,"endTime":753.44,"body":"nervous side, I probably am"},{"speaker":"Chris Dy","startTime":753.44,"endTime":756.65,"body":"going submuscular. But I don't"},{"speaker":"Chris Dy","startTime":753.44,"endTime":756.65,"body":"treat the throwing population as"},{"speaker":"Chris Dy","startTime":756.65,"endTime":758.75,"body":"much. So how does that affect"},{"speaker":"Chris Dy","startTime":756.65,"endTime":758.75,"body":"what you do?"},{"speaker":"Charles Goldfarb","startTime":760.19,"endTime":763.55,"body":"First of all,"},{"speaker":"Charles Goldfarb","startTime":760.19,"endTime":763.55,"body":"I would like to say thank you,"},{"speaker":"Charles Goldfarb","startTime":763.61,"endTime":767.84,"body":"because I have been for many"},{"speaker":"Charles Goldfarb","startTime":763.61,"endTime":767.84,"body":"years an advocate How did you do"},{"speaker":"Charles Goldfarb","startTime":767.84,"endTime":770.96,"body":"this? How did you turn this"},{"speaker":"Charles Goldfarb","startTime":767.84,"endTime":770.96,"body":"podcast into a nerve discussion?"},{"speaker":"Chris Dy","startTime":771.26,"endTime":772.97,"body":"You did, you did"},{"speaker":"Chris Dy","startTime":771.26,"endTime":772.97,"body":"actually."},{"speaker":"Charles Goldfarb","startTime":773.02,"endTime":776.26,"body":"Not"},{"speaker":"Charles Goldfarb","startTime":773.02,"endTime":776.26,"body":"intentionally and not. But will"},{"speaker":"Charles Goldfarb","startTime":776.29,"endTime":781.75,"body":"will go down this garden path. I"},{"speaker":"Charles Goldfarb","startTime":776.29,"endTime":781.75,"body":"was a an Eaton flap guy. So I"},{"speaker":"Charles Goldfarb","startTime":781.75,"endTime":784.9,"body":"raised the fascia from the"},{"speaker":"Charles Goldfarb","startTime":781.75,"endTime":784.9,"body":"flexor printer mask to prevent"},{"speaker":"Charles Goldfarb","startTime":784.9,"endTime":787.96,"body":"the nerve from subluxation."},{"speaker":"Charles Goldfarb","startTime":784.9,"endTime":787.96,"body":"Posterior Lee liked it but never"},{"speaker":"Charles Goldfarb","startTime":787.96,"endTime":791.5,"body":"loved it. Because what I think"},{"speaker":"Charles Goldfarb","startTime":787.96,"endTime":791.5,"body":"happens is the nerves, scooches"},{"speaker":"Charles Goldfarb","startTime":791.5,"endTime":793.96,"body":"and that's a nerve term that"},{"speaker":"Charles Goldfarb","startTime":791.5,"endTime":793.96,"body":"Chris likes to use a lot, the"},{"speaker":"Charles Goldfarb","startTime":793.96,"endTime":796.84,"body":"nerves scooches medially and"},{"speaker":"Charles Goldfarb","startTime":793.96,"endTime":796.84,"body":"rubs up against the medial"},{"speaker":"Charles Goldfarb","startTime":796.96,"endTime":799.93,"body":"condyle. And so I've played with"},{"speaker":"Charles Goldfarb","startTime":796.96,"endTime":799.93,"body":"different techniques, but I've"},{"speaker":"Charles Goldfarb","startTime":799.93,"endTime":803.83,"body":"never loved it, I now use that"},{"speaker":"Charles Goldfarb","startTime":799.93,"endTime":803.83,"body":"fasciocutaneous flap, as long as"},{"speaker":"Charles Goldfarb","startTime":803.86,"endTime":808.09,"body":"there is sufficient"},{"speaker":"Charles Goldfarb","startTime":803.86,"endTime":808.09,"body":"fasciocutaneous tissue and love"},{"speaker":"Charles Goldfarb","startTime":808.12,"endTime":811.96,"body":"it, I think the recovery is"},{"speaker":"Charles Goldfarb","startTime":808.12,"endTime":811.96,"body":"faster, I'm more apt to get them"},{"speaker":"Charles Goldfarb","startTime":811.96,"endTime":814.66,"body":"moving without limitations"},{"speaker":"Charles Goldfarb","startTime":811.96,"endTime":814.66,"body":"faster, which speeds an"},{"speaker":"Charles Goldfarb","startTime":814.66,"endTime":818.74,"body":"athlete's recovery. I really"},{"speaker":"Charles Goldfarb","startTime":814.66,"endTime":818.74,"body":"don't do decompressions in this"},{"speaker":"Charles Goldfarb","startTime":818.74,"endTime":821.62,"body":"population, I just don't think"},{"speaker":"Charles Goldfarb","startTime":818.74,"endTime":821.62,"body":"it has a role with the forces"},{"speaker":"Charles Goldfarb","startTime":821.62,"endTime":825.37,"body":"etc. And I don't like some"},{"speaker":"Charles Goldfarb","startTime":821.62,"endTime":825.37,"body":"muscular for I guess somewhat"},{"speaker":"Charles Goldfarb","startTime":825.37,"endTime":829.87,"body":"obvious reasons I'd rather not"},{"speaker":"Charles Goldfarb","startTime":825.37,"endTime":829.87,"body":"cut the muscle and ask it to"},{"speaker":"Charles Goldfarb","startTime":829.87,"endTime":832.72,"body":"heal and achieve the same"},{"speaker":"Charles Goldfarb","startTime":829.87,"endTime":832.72,"body":"strength that I had previously,"},{"speaker":"Charles Goldfarb","startTime":832.72,"endTime":835.72,"body":"even though it probably will. My"},{"speaker":"Charles Goldfarb","startTime":832.72,"endTime":835.72,"body":"preference is subcutaneous."},{"speaker":"Chris Dy","startTime":836.44,"endTime":838.84,"body":"Yeah, I think the key"},{"speaker":"Chris Dy","startTime":836.44,"endTime":838.84,"body":"with the subcutaneous and again,"},{"speaker":"Chris Dy","startTime":838.84,"endTime":841.54,"body":"we'll get off of the nerve"},{"speaker":"Chris Dy","startTime":838.84,"endTime":841.54,"body":"stuff, but it is making that a"},{"speaker":"Chris Dy","startTime":841.54,"endTime":845.05,"body":"very broad pillow. You know, and"},{"speaker":"Chris Dy","startTime":841.54,"endTime":845.05,"body":"making sure that you're not"},{"speaker":"Chris Dy","startTime":845.05,"endTime":846.94,"body":"doing anything that's going to"},{"speaker":"Chris Dy","startTime":845.05,"endTime":846.94,"body":"be small and tight. I think"},{"speaker":"Chris Dy","startTime":846.94,"endTime":850.27,"body":"that's my main beef with some of"},{"speaker":"Chris Dy","startTime":846.94,"endTime":850.27,"body":"the, you know, subcutaneous"},{"speaker":"Chris Dy","startTime":850.6,"endTime":853.24,"body":"transpositions that use a"},{"speaker":"Chris Dy","startTime":850.6,"endTime":853.24,"body":"fascial sling is that it? I've"},{"speaker":"Chris Dy","startTime":853.24,"endTime":858.01,"body":"seen people do it and it ends up"},{"speaker":"Chris Dy","startTime":853.24,"endTime":858.01,"body":"being a very thin band of tissue"},{"speaker":"Chris Dy","startTime":858.01,"endTime":860.5,"body":"that looks a little bit like a"},{"speaker":"Chris Dy","startTime":858.01,"endTime":860.5,"body":"transverse carpal ligament to be"},{"speaker":"Chris Dy","startTime":860.5,"endTime":863.98,"body":"honest with you once you put it"},{"speaker":"Chris Dy","startTime":860.5,"endTime":863.98,"body":"in. Then clearly it works in"},{"speaker":"Chris Dy","startTime":863.98,"endTime":867.31,"body":"many situations. But I've also"},{"speaker":"Chris Dy","startTime":863.98,"endTime":867.31,"body":"had to revise enough where I"},{"speaker":"Chris Dy","startTime":867.31,"endTime":871.87,"body":"appreciate having a very broad"},{"speaker":"Chris Dy","startTime":867.31,"endTime":871.87,"body":"area because obviously a broader"},{"speaker":"Chris Dy","startTime":871.87,"endTime":874.93,"body":"area is going to distribute the"},{"speaker":"Chris Dy","startTime":871.87,"endTime":874.93,"body":"forces more evenly the tension"},{"speaker":"Chris Dy","startTime":874.93,"endTime":877.21,"body":"more evenly across the nerve"},{"speaker":"Chris Dy","startTime":874.93,"endTime":877.21,"body":"that's been transposed."},{"speaker":"Charles Goldfarb","startTime":877.42,"endTime":880.99,"body":"Yeah, that is"},{"speaker":"Charles Goldfarb","startTime":877.42,"endTime":880.99,"body":"well said so when I do this"},{"speaker":"Charles Goldfarb","startTime":880.99,"endTime":884.47,"body":"eaten flap so to speak, it is"},{"speaker":"Charles Goldfarb","startTime":880.99,"endTime":884.47,"body":"now extraordinarily wide. It's"},{"speaker":"Charles Goldfarb","startTime":884.47,"endTime":888.04,"body":"probably half the width of the"},{"speaker":"Charles Goldfarb","startTime":884.47,"endTime":888.04,"body":"fascia of the flexor pronator"},{"speaker":"Charles Goldfarb","startTime":888.04,"endTime":890.86,"body":"mass and so it's much wider than"},{"speaker":"Charles Goldfarb","startTime":888.04,"endTime":890.86,"body":"I think I did I use when I"},{"speaker":"Charles Goldfarb","startTime":890.86,"endTime":893.98,"body":"started and I agree with you it"},{"speaker":"Charles Goldfarb","startTime":890.86,"endTime":893.98,"body":"can become a problem especially"},{"speaker":"Charles Goldfarb","startTime":893.98,"endTime":896.98,"body":"if you're not cognizant of where"},{"speaker":"Charles Goldfarb","startTime":893.98,"endTime":896.98,"body":"your skin incision lies. So do"},{"speaker":"Charles Goldfarb","startTime":896.98,"endTime":900.52,"body":"you get suture that flap"},{"speaker":"Charles Goldfarb","startTime":896.98,"endTime":900.52,"body":"anterior to the anterior skin"},{"speaker":"Charles Goldfarb","startTime":900.52,"endTime":904.93,"body":"flap to the posterior skin flap."},{"speaker":"Charles Goldfarb","startTime":900.52,"endTime":904.93,"body":"But with the fascia, cutaneous,"},{"speaker":"Charles Goldfarb","startTime":904.93,"endTime":908.5,"body":"you have this great fat, that"},{"speaker":"Charles Goldfarb","startTime":904.93,"endTime":908.5,"body":"essentially you're laying right"},{"speaker":"Charles Goldfarb","startTime":908.5,"endTime":910.21,"body":"on the nerve. And again, you"},{"speaker":"Charles Goldfarb","startTime":908.5,"endTime":910.21,"body":"want to be careful not to"},{"speaker":"Charles Goldfarb","startTime":910.21,"endTime":912.7,"body":"constrict the nerve. But you're"},{"speaker":"Charles Goldfarb","startTime":910.21,"endTime":912.7,"body":"laying it right on the nerve and"},{"speaker":"Charles Goldfarb","startTime":912.7,"endTime":916.63,"body":"what better tissue on which to,"},{"speaker":"Charles Goldfarb","startTime":912.7,"endTime":916.63,"body":"you know, have a nerve resting?"},{"speaker":"Chris Dy","startTime":917.41,"endTime":919.99,"body":"Yeah, exactly that"},{"speaker":"Chris Dy","startTime":917.41,"endTime":919.99,"body":"came up in discussion. This week"},{"speaker":"Chris Dy","startTime":919.99,"endTime":922.33,"body":"when I was working with one of"},{"speaker":"Chris Dy","startTime":919.99,"endTime":922.33,"body":"our residents, Liz Graesser, who"},{"speaker":"Chris Dy","startTime":922.33,"endTime":925.51,"body":"I'm slowly but surely assuring"},{"speaker":"Chris Dy","startTime":922.33,"endTime":925.51,"body":"her that she will be a hand"},{"speaker":"Chris Dy","startTime":925.51,"endTime":930.82,"body":"surgeon. But she's wonderful."},{"speaker":"Chris Dy","startTime":925.51,"endTime":930.82,"body":"And it's more about learning"},{"speaker":"Chris Dy","startTime":930.82,"endTime":933.34,"body":"different techniques. Because"},{"speaker":"Chris Dy","startTime":930.82,"endTime":933.34,"body":"you never know when you're in a"},{"speaker":"Chris Dy","startTime":933.34,"endTime":935.98,"body":"revision, you'll have to pull"},{"speaker":"Chris Dy","startTime":933.34,"endTime":935.98,"body":"out different types of"},{"speaker":"Chris Dy","startTime":935.98,"endTime":938.56,"body":"techniques to use because"},{"speaker":"Chris Dy","startTime":935.98,"endTime":938.56,"body":"sometimes your go to procedure"},{"speaker":"Chris Dy","startTime":938.56,"endTime":940.6,"body":"isn't going to be available,"},{"speaker":"Chris Dy","startTime":938.56,"endTime":940.6,"body":"which is what happened to us"},{"speaker":"Chris Dy","startTime":940.6,"endTime":945.76,"body":"recently in a revision so. So"},{"speaker":"Chris Dy","startTime":940.6,"endTime":945.76,"body":"thanks for the nerve talk. Let's"},{"speaker":"Chris Dy","startTime":945.76,"endTime":949.51,"body":"talk about other other injuries"},{"speaker":"Chris Dy","startTime":945.76,"endTime":949.51,"body":"that occur in the sports"},{"speaker":"Chris Dy","startTime":949.54,"endTime":951.19,"body":"population baseball in"},{"speaker":"Chris Dy","startTime":949.54,"endTime":951.19,"body":"particular."},{"speaker":"Charles Goldfarb","startTime":951.73,"endTime":953.98,"body":"Right, so I"},{"speaker":"Charles Goldfarb","startTime":951.73,"endTime":953.98,"body":"think the first if we're talking"},{"speaker":"Charles Goldfarb","startTime":953.98,"endTime":958.09,"body":"about hitters, and maybe we'll"},{"speaker":"Charles Goldfarb","startTime":953.98,"endTime":958.09,"body":"just make this about hitters,"},{"speaker":"Charles Goldfarb","startTime":958.09,"endTime":960.58,"body":"there's a few injuries, which I"},{"speaker":"Charles Goldfarb","startTime":958.09,"endTime":960.58,"body":"think we should discuss. But the"},{"speaker":"Charles Goldfarb","startTime":960.58,"endTime":963.43,"body":"first is just a basic"},{"speaker":"Charles Goldfarb","startTime":960.58,"endTime":963.43,"body":"discussion, which I don't think"},{"speaker":"Charles Goldfarb","startTime":963.43,"endTime":966.16,"body":"anyone ever explained to me not"},{"speaker":"Charles Goldfarb","startTime":963.43,"endTime":966.16,"body":"that I'm some rocket scientist"},{"speaker":"Charles Goldfarb","startTime":966.16,"endTime":968.5,"body":"or figuring out I wasn't a"},{"speaker":"Charles Goldfarb","startTime":966.16,"endTime":968.5,"body":"baseball player. But if"},{"speaker":"Charles Goldfarb","startTime":968.5,"endTime":972.52,"body":"listeners are not baseball"},{"speaker":"Charles Goldfarb","startTime":968.5,"endTime":972.52,"body":"people, hopefully this setting"},{"speaker":"Charles Goldfarb","startTime":972.52,"endTime":977.53,"body":"the stage helps. So if you're a"},{"speaker":"Charles Goldfarb","startTime":972.52,"endTime":977.53,"body":"right handed batter, what that"},{"speaker":"Charles Goldfarb","startTime":977.53,"endTime":982.21,"body":"means is, your left hand is"},{"speaker":"Charles Goldfarb","startTime":977.53,"endTime":982.21,"body":"below your right hand on the"},{"speaker":"Charles Goldfarb","startTime":982.21,"endTime":987.73,"body":"bat. And you're standing at the"},{"speaker":"Charles Goldfarb","startTime":982.21,"endTime":987.73,"body":"plate. And when you swing, it's"},{"speaker":"Charles Goldfarb","startTime":987.73,"endTime":992.41,"body":"really all about your left hand,"},{"speaker":"Charles Goldfarb","startTime":987.73,"endTime":992.41,"body":"your right hands on the bat to"},{"speaker":"Charles Goldfarb","startTime":992.41,"endTime":995.38,"body":"stabilize it. But when you swing"},{"speaker":"Charles Goldfarb","startTime":992.41,"endTime":995.38,"body":"and then when you follow"},{"speaker":"Charles Goldfarb","startTime":995.38,"endTime":999.43,"body":"through, you end up ulnar"},{"speaker":"Charles Goldfarb","startTime":995.38,"endTime":999.43,"body":"deviating the wrist at the final"},{"speaker":"Charles Goldfarb","startTime":999.43,"endTime":1004.14,"body":"follow through. It's all left"},{"speaker":"Charles Goldfarb","startTime":999.43,"endTime":1004.14,"body":"hand or non dominant hand"},{"speaker":"Charles Goldfarb","startTime":1004.14,"endTime":1008.01,"body":"depending on on factors. But a"},{"speaker":"Charles Goldfarb","startTime":1004.14,"endTime":1008.01,"body":"right handed batter is at risk"},{"speaker":"Charles Goldfarb","startTime":1008.01,"endTime":1012.12,"body":"for left wrist issues. And I"},{"speaker":"Charles Goldfarb","startTime":1008.01,"endTime":1012.12,"body":"think we can briefly discuss"},{"speaker":"Charles Goldfarb","startTime":1012.12,"endTime":1017.58,"body":"three somewhat common issues one"},{"speaker":"Charles Goldfarb","startTime":1012.12,"endTime":1017.58,"body":"is going to have a fracture to"},{"speaker":"Charles Goldfarb","startTime":1017.58,"endTime":1021.27,"body":"his TFCC. And we don't need to"},{"speaker":"Charles Goldfarb","startTime":1017.58,"endTime":1021.27,"body":"go into detail, and three is the"},{"speaker":"Charles Goldfarb","startTime":1021.27,"endTime":1024.57,"body":"ECU tendon. Those are the three"},{"speaker":"Charles Goldfarb","startTime":1021.27,"endTime":1024.57,"body":"that immediately jumped to my"},{"speaker":"Charles Goldfarb","startTime":1024.57,"endTime":1027.39,"body":"mind. I don't know if you have"},{"speaker":"Charles Goldfarb","startTime":1024.57,"endTime":1027.39,"body":"general comments before we dive"},{"speaker":"Charles Goldfarb","startTime":1027.39,"endTime":1027.57,"body":"in."},{"speaker":"Chris Dy","startTime":1027.96,"endTime":1029.4,"body":"I mean, it's the first"},{"speaker":"Chris Dy","startTime":1027.96,"endTime":1029.4,"body":"thing that came to mind with"},{"speaker":"Chris Dy","startTime":1029.4,"endTime":1031.86,"body":"that kind of follow through and"},{"speaker":"Chris Dy","startTime":1029.4,"endTime":1031.86,"body":"the ulnar deviation, obviously"},{"speaker":"Chris Dy","startTime":1031.86,"endTime":1034.47,"body":"is ECU does the first"},{"speaker":"Chris Dy","startTime":1031.86,"endTime":1034.47,"body":"compartment ever getting"},{"speaker":"Chris Dy","startTime":1034.47,"endTime":1036.9,"body":"irritated the first source of"},{"speaker":"Chris Dy","startTime":1034.47,"endTime":1036.9,"body":"compartment with that repetitive"},{"speaker":"Chris Dy","startTime":1036.9,"endTime":1038.34,"body":"ulnar deviation moment?"},{"speaker":"Charles Goldfarb","startTime":1038.85,"endTime":1041.67,"body":"No, it seems"},{"speaker":"Charles Goldfarb","startTime":1038.85,"endTime":1041.67,"body":"to be resistant? I haven't I"},{"speaker":"Charles Goldfarb","startTime":1041.67,"endTime":1044.22,"body":"haven't experienced that. I'm"},{"speaker":"Charles Goldfarb","startTime":1041.67,"endTime":1044.22,"body":"trying to think of I've ever"},{"speaker":"Charles Goldfarb","startTime":1044.22,"endTime":1047.55,"body":"even seen radial side of issues."},{"speaker":"Charles Goldfarb","startTime":1044.22,"endTime":1047.55,"body":"Of course I'm sure I have. But"},{"speaker":"Charles Goldfarb","startTime":1047.55,"endTime":1050.49,"body":"they just regular sided issues"},{"speaker":"Charles Goldfarb","startTime":1047.55,"endTime":1050.49,"body":"are uncommon in general."},{"speaker":"Chris Dy","startTime":1050.82,"endTime":1052.71,"body":"So let's talk about"},{"speaker":"Chris Dy","startTime":1050.82,"endTime":1052.71,"body":"that hook of the hamate fracture"},{"speaker":"Chris Dy","startTime":1052.71,"endTime":1056.1,"body":"is that with specific types of"},{"speaker":"Chris Dy","startTime":1052.71,"endTime":1056.1,"body":"impact, or is it a repetitive"},{"speaker":"Chris Dy","startTime":1056.13,"endTime":1057.78,"body":"kind of stress to the bone?"},{"speaker":"Charles Goldfarb","startTime":1059.04,"endTime":1061.68,"body":"To me, it's a"},{"speaker":"Charles Goldfarb","startTime":1059.04,"endTime":1061.68,"body":"repetitive stress to the bone,"},{"speaker":"Charles Goldfarb","startTime":1062.22,"endTime":1066.84,"body":"there is evidence, it's actually"},{"speaker":"Charles Goldfarb","startTime":1062.22,"endTime":1066.84,"body":"pretty good that the handle of"},{"speaker":"Charles Goldfarb","startTime":1066.84,"endTime":1071.01,"body":"the bat, I'm sorry, the knob of"},{"speaker":"Charles Goldfarb","startTime":1066.84,"endTime":1071.01,"body":"the bat, which you know is the"},{"speaker":"Charles Goldfarb","startTime":1071.01,"endTime":1076.53,"body":"very bottom of the bat impacts"},{"speaker":"Charles Goldfarb","startTime":1071.01,"endTime":1076.53,"body":"this and there are bats that"},{"speaker":"Charles Goldfarb","startTime":1076.53,"endTime":1082.56,"body":"have a different shape knob that"},{"speaker":"Charles Goldfarb","startTime":1076.53,"endTime":1082.56,"body":"seem to decrease the risk of"},{"speaker":"Charles Goldfarb","startTime":1082.56,"endTime":1085.44,"body":"this repetitive stress on the"},{"speaker":"Charles Goldfarb","startTime":1082.56,"endTime":1085.44,"body":"hook of the hamate. And if you"},{"speaker":"Charles Goldfarb","startTime":1085.44,"endTime":1091.32,"body":"see a a hitter, who's been in"},{"speaker":"Charles Goldfarb","startTime":1085.44,"endTime":1091.32,"body":"the cage a lot, they'll have"},{"speaker":"Charles Goldfarb","startTime":1091.32,"endTime":1095.52,"body":"calluses right over the open to"},{"speaker":"Charles Goldfarb","startTime":1091.32,"endTime":1095.52,"body":"me. And so you're getting"},{"speaker":"Charles Goldfarb","startTime":1095.55,"endTime":1099.12,"body":"repetitive force. And I do"},{"speaker":"Charles Goldfarb","startTime":1095.55,"endTime":1099.12,"body":"believe this is a repetitive"},{"speaker":"Charles Goldfarb","startTime":1099.12,"endTime":1102.9,"body":"issue. And then at some point,"},{"speaker":"Charles Goldfarb","startTime":1099.12,"endTime":1102.9,"body":"you get the fracture the hook or"},{"speaker":"Charles Goldfarb","startTime":1102.9,"endTime":1105.18,"body":"the hamate. And when that"},{"speaker":"Charles Goldfarb","startTime":1102.9,"endTime":1105.18,"body":"happens, you can't swing"},{"speaker":"Charles Goldfarb","startTime":1105.18,"endTime":1108.0,"body":"anymore. So I don't think it's"},{"speaker":"Charles Goldfarb","startTime":1105.18,"endTime":1108.0,"body":"usually everything's fine,"},{"speaker":"Charles Goldfarb","startTime":1108.0,"endTime":1110.25,"body":"everything's fine. And then you"},{"speaker":"Charles Goldfarb","startTime":1108.0,"endTime":1110.25,"body":"break instead, I think it's"},{"speaker":"Charles Goldfarb","startTime":1110.37,"endTime":1113.73,"body":"micro trauma, micro trauma,"},{"speaker":"Charles Goldfarb","startTime":1110.37,"endTime":1113.73,"body":"micro trauma, and then"},{"speaker":"Charles Goldfarb","startTime":1113.73,"endTime":1118.29,"body":"ultimately the fracture. And we"},{"speaker":"Charles Goldfarb","startTime":1113.73,"endTime":1118.29,"body":"know that it's at this area of"},{"speaker":"Charles Goldfarb","startTime":1118.29,"endTime":1121.14,"body":"poor blood supply, where the"},{"speaker":"Charles Goldfarb","startTime":1118.29,"endTime":1121.14,"body":"hook meets the body of the"},{"speaker":"Charles Goldfarb","startTime":1121.14,"endTime":1125.94,"body":"hamate, ultimately it breaks."},{"speaker":"Charles Goldfarb","startTime":1121.14,"endTime":1125.94,"body":"And I think it's become more"},{"speaker":"Charles Goldfarb","startTime":1125.94,"endTime":1129.12,"body":"clear to be direct in our"},{"speaker":"Charles Goldfarb","startTime":1125.94,"endTime":1129.12,"body":"approach to treatment."},{"speaker":"Chris Dy","startTime":1129.75,"endTime":1132.72,"body":"So what's the what's"},{"speaker":"Chris Dy","startTime":1129.75,"endTime":1132.72,"body":"the calculation there? Do you"},{"speaker":"Chris Dy","startTime":1132.72,"endTime":1135.48,"body":"just excise it, pluck it out?"},{"speaker":"Chris Dy","startTime":1132.72,"endTime":1135.48,"body":"And you're done? Can they get"},{"speaker":"Chris Dy","startTime":1135.48,"endTime":1137.76,"body":"back to batting after that? Or"},{"speaker":"Chris Dy","startTime":1135.48,"endTime":1137.76,"body":"do you have to fix that thing?"},{"speaker":"Charles Goldfarb","startTime":1138.3,"endTime":1140.91,"body":"So surgical"},{"speaker":"Charles Goldfarb","startTime":1138.3,"endTime":1140.91,"body":"repair of hook of the hamate in"},{"speaker":"Charles Goldfarb","startTime":1140.91,"endTime":1144.78,"body":"my mind is a no go. It doesn't"},{"speaker":"Charles Goldfarb","startTime":1140.91,"endTime":1144.78,"body":"make any sense for a couple"},{"speaker":"Charles Goldfarb","startTime":1144.78,"endTime":1149.58,"body":"reasons. One, you're trying to"},{"speaker":"Charles Goldfarb","startTime":1144.78,"endTime":1149.58,"body":"get a poorly vascularized area"},{"speaker":"Charles Goldfarb","startTime":1149.64,"endTime":1154.98,"body":"and small area of bone to heal"},{"speaker":"Charles Goldfarb","startTime":1149.64,"endTime":1154.98,"body":"to doesn't seem like anyone ever"},{"speaker":"Charles Goldfarb","startTime":1154.98,"endTime":1159.6,"body":"misses the hook of the hamate,"},{"speaker":"Charles Goldfarb","startTime":1154.98,"endTime":1159.6,"body":"even with high level performers,"},{"speaker":"Charles Goldfarb","startTime":1159.6,"endTime":1164.1,"body":"such as baseball players, and so"},{"speaker":"Charles Goldfarb","startTime":1159.6,"endTime":1164.1,"body":"you can cast somebody if you"},{"speaker":"Charles Goldfarb","startTime":1164.1,"endTime":1166.98,"body":"want. And again, hold your"},{"speaker":"Charles Goldfarb","startTime":1164.1,"endTime":1166.98,"body":"breath and hope hope hope but to"},{"speaker":"Charles Goldfarb","startTime":1166.98,"endTime":1170.25,"body":"me, that doesn't make sense."},{"speaker":"Charles Goldfarb","startTime":1166.98,"endTime":1170.25,"body":"Even if it's a non traditional,"},{"speaker":"Charles Goldfarb","startTime":1170.25,"endTime":1173.01,"body":"we're gonna have a fracture"},{"speaker":"Charles Goldfarb","startTime":1170.25,"endTime":1173.01,"body":"meaning and acute trauma in a"},{"speaker":"Charles Goldfarb","startTime":1173.01,"endTime":1175.71,"body":"non baseball player. I just"},{"speaker":"Charles Goldfarb","startTime":1173.01,"endTime":1175.71,"body":"don't think it has much of a"},{"speaker":"Charles Goldfarb","startTime":1175.71,"endTime":1180.75,"body":"role. And so for me it is hook"},{"speaker":"Charles Goldfarb","startTime":1175.71,"endTime":1180.75,"body":"of the hamate excision is a very"},{"speaker":"Charles Goldfarb","startTime":1180.99,"endTime":1182.16,"body":"satisfying surgery."},{"speaker":"Chris Dy","startTime":1182.99,"endTime":1186.35,"body":"So is it that you"},{"speaker":"Chris Dy","startTime":1182.99,"endTime":1186.35,"body":"mentioned after they have this"},{"speaker":"Chris Dy","startTime":1186.35,"endTime":1189.14,"body":"kind of repetitive stress injury"},{"speaker":"Chris Dy","startTime":1186.35,"endTime":1189.14,"body":"to the hook of the hamate that"},{"speaker":"Chris Dy","startTime":1189.14,"endTime":1191.87,"body":"they can't bat anymore? Is it"},{"speaker":"Chris Dy","startTime":1189.14,"endTime":1191.87,"body":"because of the pain from the"},{"speaker":"Chris Dy","startTime":1191.87,"endTime":1194.69,"body":"fracture that they can't bat so"},{"speaker":"Chris Dy","startTime":1191.87,"endTime":1194.69,"body":"you know excising the hook of"},{"speaker":"Chris Dy","startTime":1194.69,"endTime":1198.35,"body":"the hamate once they get over"},{"speaker":"Chris Dy","startTime":1194.69,"endTime":1198.35,"body":"the surgical pain is that is"},{"speaker":"Chris Dy","startTime":1198.35,"endTime":1201.44,"body":"there any role of mechanical"},{"speaker":"Chris Dy","startTime":1198.35,"endTime":1201.44,"body":"support against the hook of the"},{"speaker":"Chris Dy","startTime":1201.44,"endTime":1202.79,"body":"hamate in terms of the bat?"},{"speaker":"Charles Goldfarb","startTime":1203.36,"endTime":1205.49,"body":"No, I think"},{"speaker":"Charles Goldfarb","startTime":1203.36,"endTime":1205.49,"body":"once you well, you know, once"},{"speaker":"Charles Goldfarb","startTime":1205.49,"endTime":1207.62,"body":"you treat it and take it out,"},{"speaker":"Charles Goldfarb","startTime":1205.49,"endTime":1207.62,"body":"you're done. And it's just a"},{"speaker":"Charles Goldfarb","startTime":1207.62,"endTime":1210.5,"body":"matter of when they get back to"},{"speaker":"Charles Goldfarb","startTime":1207.62,"endTime":1210.5,"body":"batting. And so, you know, we"},{"speaker":"Charles Goldfarb","startTime":1210.5,"endTime":1213.86,"body":"shared our experience, Doug"},{"speaker":"Charles Goldfarb","startTime":1210.5,"endTime":1213.86,"body":"Carlin and I and Doug was a"},{"speaker":"Charles Goldfarb","startTime":1213.86,"endTime":1217.25,"body":"fellow here, way back maybe 20"},{"speaker":"Charles Goldfarb","startTime":1213.86,"endTime":1217.25,"body":"years ago. And he has helped"},{"speaker":"Charles Goldfarb","startTime":1217.25,"endTime":1220.73,"body":"take care of the race for many"},{"speaker":"Charles Goldfarb","startTime":1217.25,"endTime":1220.73,"body":"years. And then there's been a"},{"speaker":"Charles Goldfarb","startTime":1220.73,"endTime":1223.13,"body":"couple other papers recently a"},{"speaker":"Charles Goldfarb","startTime":1220.73,"endTime":1223.13,"body":"paper out of Phoenix with a"},{"speaker":"Charles Goldfarb","startTime":1223.13,"endTime":1226.16,"body":"large series as well. The"},{"speaker":"Charles Goldfarb","startTime":1223.13,"endTime":1226.16,"body":"message is the same people, you"},{"speaker":"Charles Goldfarb","startTime":1226.16,"endTime":1229.85,"body":"know, players do well with vocal"},{"speaker":"Charles Goldfarb","startTime":1226.16,"endTime":1229.85,"body":"damage decision, the question is"},{"speaker":"Charles Goldfarb","startTime":1230.3,"endTime":1235.19,"body":"risk of complications and return"},{"speaker":"Charles Goldfarb","startTime":1230.3,"endTime":1235.19,"body":"in timing of return to play. I"},{"speaker":"Charles Goldfarb","startTime":1235.19,"endTime":1238.19,"body":"think an experience hands the"},{"speaker":"Charles Goldfarb","startTime":1235.19,"endTime":1238.19,"body":"risk is low. But sometimes the"},{"speaker":"Charles Goldfarb","startTime":1238.19,"endTime":1240.32,"body":"nerve gets irritable after"},{"speaker":"Charles Goldfarb","startTime":1238.19,"endTime":1240.32,"body":"surgery, I would say that's the"},{"speaker":"Charles Goldfarb","startTime":1240.32,"endTime":1245.9,"body":"biggest risk. And the second"},{"speaker":"Charles Goldfarb","startTime":1240.32,"endTime":1245.9,"body":"issue is return to play. And so"},{"speaker":"Charles Goldfarb","startTime":1246.2,"endTime":1251.54,"body":"I tell people to expect six to"},{"speaker":"Charles Goldfarb","startTime":1246.2,"endTime":1251.54,"body":"eight weeks, but it is highly"},{"speaker":"Charles Goldfarb","startTime":1251.54,"endTime":1256.28,"body":"variable. I think some players"},{"speaker":"Charles Goldfarb","startTime":1251.54,"endTime":1256.28,"body":"are back, batting at two to"},{"speaker":"Charles Goldfarb","startTime":1256.28,"endTime":1259.94,"body":"three weeks and playing full"},{"speaker":"Charles Goldfarb","startTime":1256.28,"endTime":1259.94,"body":"bore by four weeks, and rarely"},{"speaker":"Charles Goldfarb","startTime":1259.94,"endTime":1263.0,"body":"get someone who takes longer. So"},{"speaker":"Charles Goldfarb","startTime":1259.94,"endTime":1263.0,"body":"that's the part that's hard to"},{"speaker":"Charles Goldfarb","startTime":1263.0,"endTime":1266.96,"body":"predict. But it's based on pain"},{"speaker":"Charles Goldfarb","startTime":1263.0,"endTime":1266.96,"body":"and tolerance."},{"speaker":"Chris Dy","startTime":1267.38,"endTime":1269.51,"body":"Assuming everything"},{"speaker":"Chris Dy","startTime":1267.38,"endTime":1269.51,"body":"goes the way you expect it to in"},{"speaker":"Chris Dy","startTime":1269.51,"endTime":1272.66,"body":"surgery and the wound heals."},{"speaker":"Chris Dy","startTime":1269.51,"endTime":1272.66,"body":"When will you allow them to"},{"speaker":"Chris Dy","startTime":1272.66,"endTime":1274.19,"body":"start batting the test things"},{"speaker":"Chris Dy","startTime":1272.66,"endTime":1274.19,"body":"out?"},{"speaker":"Charles Goldfarb","startTime":1274.88,"endTime":1276.56,"body":"Yeah, easily"},{"speaker":"Charles Goldfarb","startTime":1274.88,"endTime":1276.56,"body":"at three weeks, I'll say if you"},{"speaker":"Charles Goldfarb","startTime":1276.56,"endTime":1280.22,"body":"want to take a lightweight bat,"},{"speaker":"Charles Goldfarb","startTime":1276.56,"endTime":1280.22,"body":"and do some light hitting off a"},{"speaker":"Charles Goldfarb","startTime":1280.22,"endTime":1283.88,"body":"tee I'm fine with it or even you"},{"speaker":"Charles Goldfarb","startTime":1280.22,"endTime":1283.88,"body":"know, swinging a wiffle ball bat"},{"speaker":"Charles Goldfarb","startTime":1283.88,"endTime":1286.19,"body":"or something like that, and then"},{"speaker":"Charles Goldfarb","startTime":1283.88,"endTime":1286.19,"body":"go to you know, progress from"},{"speaker":"Charles Goldfarb","startTime":1286.19,"endTime":1289.85,"body":"there. But some people look at"},{"speaker":"Charles Goldfarb","startTime":1286.19,"endTime":1289.85,"body":"me like there's no way that's"},{"speaker":"Charles Goldfarb","startTime":1289.85,"endTime":1292.31,"body":"happening in two to three weeks"},{"speaker":"Charles Goldfarb","startTime":1289.85,"endTime":1292.31,"body":"and other people's will say at"},{"speaker":"Charles Goldfarb","startTime":1292.31,"endTime":1294.98,"body":"their first post visit. Hey,"},{"speaker":"Charles Goldfarb","startTime":1292.31,"endTime":1294.98,"body":"I've been taking swings and"},{"speaker":"Charles Goldfarb","startTime":1294.98,"endTime":1295.52,"body":"doing fine."},{"speaker":"Chris Dy","startTime":1295.94,"endTime":1297.92,"body":"Is it the weight of"},{"speaker":"Chris Dy","startTime":1295.94,"endTime":1297.92,"body":"the bat or the velocity of the"},{"speaker":"Chris Dy","startTime":1297.92,"endTime":1298.37,"body":"effort?"},{"speaker":"Charles Goldfarb","startTime":1299.06,"endTime":1300.71,"body":"I think it's a"},{"speaker":"Charles Goldfarb","startTime":1299.06,"endTime":1300.71,"body":"combination. That's why the"},{"speaker":"Charles Goldfarb","startTime":1300.71,"endTime":1302.78,"body":"lighter swings and the lighter"},{"speaker":"Charles Goldfarb","startTime":1300.71,"endTime":1302.78,"body":"bat help."},{"speaker":"Chris Dy","startTime":1303.56,"endTime":1306.47,"body":"I got to ask you, you"},{"speaker":"Chris Dy","startTime":1303.56,"endTime":1306.47,"body":"mentioned nerve before I did the"},{"speaker":"Chris Dy","startTime":1306.47,"endTime":1309.53,"body":"you routinely decompresses zone"},{"speaker":"Chris Dy","startTime":1306.47,"endTime":1309.53,"body":"two of Guyon's canal as you do"},{"speaker":"Chris Dy","startTime":1309.53,"endTime":1312.02,"body":"this, or do you just make sure"},{"speaker":"Chris Dy","startTime":1309.53,"endTime":1312.02,"body":"you visualize the nerve."},{"speaker":"Charles Goldfarb","startTime":1312.53,"endTime":1314.93,"body":"So I mean,"},{"speaker":"Charles Goldfarb","startTime":1312.53,"endTime":1314.93,"body":"that is obviously the risk I"},{"speaker":"Charles Goldfarb","startTime":1314.93,"endTime":1321.41,"body":"believe in fully exposing the"},{"speaker":"Charles Goldfarb","startTime":1314.93,"endTime":1321.41,"body":"nerve, careful retraction. And"},{"speaker":"Charles Goldfarb","startTime":1321.41,"endTime":1324.59,"body":"that means a little bit wider"},{"speaker":"Charles Goldfarb","startTime":1321.41,"endTime":1324.59,"body":"decompression so that you don't"},{"speaker":"Charles Goldfarb","startTime":1324.86,"endTime":1329.12,"body":"retract it at one little point"},{"speaker":"Charles Goldfarb","startTime":1324.86,"endTime":1329.12,"body":"and not over retracting, which"},{"speaker":"Charles Goldfarb","startTime":1329.12,"endTime":1332.09,"body":"is going to cause you know,"},{"speaker":"Charles Goldfarb","startTime":1329.12,"endTime":1332.09,"body":"potentially some tingling in the"},{"speaker":"Charles Goldfarb","startTime":1332.09,"endTime":1334.82,"body":"finger thereafter. And obviously"},{"speaker":"Charles Goldfarb","startTime":1332.09,"endTime":1334.82,"body":"that's the risk of the surgery."},{"speaker":"Charles Goldfarb","startTime":1334.82,"endTime":1340.01,"body":"And so, yes, I suppose I protect"},{"speaker":"Charles Goldfarb","startTime":1334.82,"endTime":1340.01,"body":"and that's the only thing you"},{"speaker":"Charles Goldfarb","startTime":1340.01,"endTime":1342.56,"body":"know, it's if you think it's a"},{"speaker":"Charles Goldfarb","startTime":1340.01,"endTime":1342.56,"body":"really small little piece of"},{"speaker":"Charles Goldfarb","startTime":1342.56,"endTime":1345.77,"body":"bone and you make a small"},{"speaker":"Charles Goldfarb","startTime":1342.56,"endTime":1345.77,"body":"incision, you take it out, not"},{"speaker":"Charles Goldfarb","startTime":1345.77,"endTime":1350.84,"body":"really my approach. Still a palm"},{"speaker":"Charles Goldfarb","startTime":1345.77,"endTime":1350.84,"body":"only incision. I don't like to"},{"speaker":"Charles Goldfarb","startTime":1350.84,"endTime":1353.3,"body":"cross the wrist crease because"},{"speaker":"Charles Goldfarb","startTime":1350.84,"endTime":1353.3,"body":"that wrist crease crossing"},{"speaker":"Charles Goldfarb","startTime":1353.3,"endTime":1357.17,"body":"incision gets irritable. But"},{"speaker":"Charles Goldfarb","startTime":1353.3,"endTime":1357.17,"body":"find the nerve expose the nerve,"},{"speaker":"Charles Goldfarb","startTime":1357.17,"endTime":1359.06,"body":"gently retract the nerve, take"},{"speaker":"Charles Goldfarb","startTime":1357.17,"endTime":1359.06,"body":"out the hook."},{"speaker":"Chris Dy","startTime":1360.29,"endTime":1362.9,"body":"If anybody out there"},{"speaker":"Chris Dy","startTime":1360.29,"endTime":1362.9,"body":"repairs these and has adequate"},{"speaker":"Chris Dy","startTime":1362.9,"endTime":1365.51,"body":"experience repairing hook of the"},{"speaker":"Chris Dy","startTime":1362.9,"endTime":1365.51,"body":"hamate fractures, let us know,"},{"speaker":"Chris Dy","startTime":1365.96,"endTime":1369.05,"body":"Chuck is saying that the"},{"speaker":"Chris Dy","startTime":1365.96,"endTime":1369.05,"body":"literature would point to"},{"speaker":"Chris Dy","startTime":1369.05,"endTime":1371.84,"body":"otherwise. But if that's your"},{"speaker":"Chris Dy","startTime":1369.05,"endTime":1371.84,"body":"experience, please let us know."},{"speaker":"Charles Goldfarb","startTime":1372.17,"endTime":1374.21,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":1372.17,"endTime":1374.21,"body":"And I'll say one thing before we"},{"speaker":"Charles Goldfarb","startTime":1374.21,"endTime":1378.02,"body":"switch topics. Don't get fooled"},{"speaker":"Charles Goldfarb","startTime":1374.21,"endTime":1378.02,"body":"by thinking the hook of the"},{"speaker":"Charles Goldfarb","startTime":1378.02,"endTime":1384.77,"body":"hamate is always the only issue."},{"speaker":"Charles Goldfarb","startTime":1378.02,"endTime":1384.77,"body":"So two comments there one, the"},{"speaker":"Charles Goldfarb","startTime":1384.77,"endTime":1387.68,"body":"physical exam is pretty classic,"},{"speaker":"Charles Goldfarb","startTime":1384.77,"endTime":1387.68,"body":"right? You feel the piece of"},{"speaker":"Charles Goldfarb","startTime":1387.68,"endTime":1390.77,"body":"form, you go about a centimeter,"},{"speaker":"Charles Goldfarb","startTime":1387.68,"endTime":1390.77,"body":"centimeter and a half, distal"},{"speaker":"Charles Goldfarb","startTime":1390.77,"endTime":1395.39,"body":"and radial. And you put your"},{"speaker":"Charles Goldfarb","startTime":1390.77,"endTime":1395.39,"body":"finger on the hook. And most"},{"speaker":"Charles Goldfarb","startTime":1395.39,"endTime":1398.6,"body":"people are most painful there."},{"speaker":"Charles Goldfarb","startTime":1395.39,"endTime":1398.6,"body":"And if there's no other pain,"},{"speaker":"Charles Goldfarb","startTime":1398.63,"endTime":1402.71,"body":"great. The other test you can do"},{"speaker":"Charles Goldfarb","startTime":1398.63,"endTime":1402.71,"body":"is resisted little finger"},{"speaker":"Charles Goldfarb","startTime":1402.74,"endTime":1405.44,"body":"flexion. And you know, you can"},{"speaker":"Charles Goldfarb","startTime":1402.74,"endTime":1405.44,"body":"think about the flexor tendons"},{"speaker":"Charles Goldfarb","startTime":1405.44,"endTime":1408.77,"body":"wrapping around the hook that"},{"speaker":"Charles Goldfarb","startTime":1405.44,"endTime":1408.77,"body":"will be painful, and often"},{"speaker":"Charles Goldfarb","startTime":1408.77,"endTime":1412.1,"body":"positive. But sometimes it's"},{"speaker":"Charles Goldfarb","startTime":1408.77,"endTime":1412.1,"body":"just a little vague. And some"},{"speaker":"Charles Goldfarb","startTime":1412.1,"endTime":1415.61,"body":"people have pain dorsally or"},{"speaker":"Charles Goldfarb","startTime":1412.1,"endTime":1415.61,"body":"overly over the over the hamate"},{"speaker":"Charles Goldfarb","startTime":1415.61,"endTime":1418.43,"body":"bone itself. And some people a"},{"speaker":"Charles Goldfarb","startTime":1415.61,"endTime":1418.43,"body":"little approximately at the"},{"speaker":"Charles Goldfarb","startTime":1418.43,"endTime":1422.84,"body":"fovea. So I just the warning is"},{"speaker":"Charles Goldfarb","startTime":1418.43,"endTime":1422.84,"body":"don't be too quick to say this"},{"speaker":"Charles Goldfarb","startTime":1422.84,"endTime":1425.27,"body":"is absolutely hopefully hamate"},{"speaker":"Charles Goldfarb","startTime":1422.84,"endTime":1425.27,"body":"and nothing else is going on."},{"speaker":"Charles Goldfarb","startTime":1425.48,"endTime":1427.04,"body":"Try to make sure nothing else is"},{"speaker":"Charles Goldfarb","startTime":1425.48,"endTime":1427.04,"body":"going on."},{"speaker":"Chris Dy","startTime":1427.73,"endTime":1429.56,"body":"Are there cases in"},{"speaker":"Chris Dy","startTime":1427.73,"endTime":1429.56,"body":"which you're getting advanced"},{"speaker":"Chris Dy","startTime":1429.56,"endTime":1432.47,"body":"imaging like an MRI and looking"},{"speaker":"Chris Dy","startTime":1429.56,"endTime":1432.47,"body":"for edema pattern or anything"},{"speaker":"Chris Dy","startTime":1432.47,"endTime":1434.81,"body":"like that in the hook? And if"},{"speaker":"Chris Dy","startTime":1432.47,"endTime":1434.81,"body":"you see that, are you going to"},{"speaker":"Chris Dy","startTime":1434.81,"endTime":1439.01,"body":"stop them and mobilize them and"},{"speaker":"Chris Dy","startTime":1434.81,"endTime":1439.01,"body":"slow them down before? Obviously"},{"speaker":"Chris Dy","startTime":1439.01,"endTime":1441.11,"body":"you're not going to take out a"},{"speaker":"Chris Dy","startTime":1439.01,"endTime":1441.11,"body":"hook that's not broken? Or will"},{"speaker":"Chris Dy","startTime":1441.11,"endTime":1441.32,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":1442.01,"endTime":1445.4,"body":"Yeah, so"},{"speaker":"Charles Goldfarb","startTime":1442.01,"endTime":1445.4,"body":"carpal tunnel view is the X ray"},{"speaker":"Charles Goldfarb","startTime":1445.4,"endTime":1448.37,"body":"of choice. No other x ray has"},{"speaker":"Charles Goldfarb","startTime":1445.4,"endTime":1448.37,"body":"the potential to show this if"},{"speaker":"Charles Goldfarb","startTime":1448.37,"endTime":1451.85,"body":"the X ray is not confirmatory,"},{"speaker":"Charles Goldfarb","startTime":1448.37,"endTime":1451.85,"body":"despite a strong clinical"},{"speaker":"Charles Goldfarb","startTime":1451.85,"endTime":1456.98,"body":"suspicion than either MRI or CT"},{"speaker":"Charles Goldfarb","startTime":1451.85,"endTime":1456.98,"body":"can be helpful. If it's broken,"},{"speaker":"Charles Goldfarb","startTime":1457.01,"endTime":1460.91,"body":"you deal with it even if it's"},{"speaker":"Charles Goldfarb","startTime":1457.01,"endTime":1460.91,"body":"non displaced in my mind. The"},{"speaker":"Charles Goldfarb","startTime":1460.91,"endTime":1465.26,"body":"question of course is when it is"},{"speaker":"Charles Goldfarb","startTime":1460.91,"endTime":1465.26,"body":"not broken and you do try to"},{"speaker":"Charles Goldfarb","startTime":1465.26,"endTime":1468.53,"body":"rest you try to let them rest"},{"speaker":"Charles Goldfarb","startTime":1465.26,"endTime":1468.53,"body":"and I don't like to take out non"},{"speaker":"Charles Goldfarb","startTime":1468.53,"endTime":1471.95,"body":"broken hooks but edema is highly"},{"speaker":"Charles Goldfarb","startTime":1468.53,"endTime":1471.95,"body":"concerning and you gotta you"},{"speaker":"Charles Goldfarb","startTime":1471.95,"endTime":1474.5,"body":"have to get that to resolve or"},{"speaker":"Charles Goldfarb","startTime":1471.95,"endTime":1474.5,"body":"else you're gonna be back"},{"speaker":"Charles Goldfarb","startTime":1474.5,"endTime":1476.45,"body":"talking to this player in"},{"speaker":"Charles Goldfarb","startTime":1474.5,"endTime":1476.45,"body":"another three months."},{"speaker":"Chris Dy","startTime":1476.69,"endTime":1478.61,"body":"I can just see you in"},{"speaker":"Chris Dy","startTime":1476.69,"endTime":1478.61,"body":"there with your osteotome"},{"speaker":"Chris Dy","startTime":1478.61,"endTime":1481.4,"body":"chipping out that hook of the"},{"speaker":"Chris Dy","startTime":1478.61,"endTime":1481.4,"body":"hamate  tinkling the recurrent"},{"speaker":"Chris Dy","startTime":1481.4,"endTime":1484.67,"body":"motor branch or the deep motor"},{"speaker":"Chris Dy","startTime":1481.4,"endTime":1484.67,"body":"branch, so don't do that."},{"speaker":"Charles Goldfarb","startTime":1485.24,"endTime":1487.22,"body":"Definitely not"},{"speaker":"Charles Goldfarb","startTime":1485.24,"endTime":1487.22,"body":"definitely not."},{"speaker":"Chris Dy","startTime":1487.49,"endTime":1490.31,"body":"So you mentioned TFCC"},{"speaker":"Chris Dy","startTime":1487.49,"endTime":1490.31,"body":"as the next kind of group of"},{"speaker":"Chris Dy","startTime":1490.31,"endTime":1496.04,"body":"issues. Next in a group of"},{"speaker":"Chris Dy","startTime":1490.31,"endTime":1496.04,"body":"issues for batters. How is is"},{"speaker":"Chris Dy","startTime":1496.04,"endTime":1499.58,"body":"the pathology different there"},{"speaker":"Chris Dy","startTime":1496.04,"endTime":1499.58,"body":"compared to any other TFCC"},{"speaker":"Chris Dy","startTime":1499.58,"endTime":1500.0,"body":"injury?"},{"speaker":"Charles Goldfarb","startTime":1500.39,"endTime":1502.34,"body":"I don't think"},{"speaker":"Charles Goldfarb","startTime":1500.39,"endTime":1502.34,"body":"so. And there's not a pattern"},{"speaker":"Charles Goldfarb","startTime":1502.34,"endTime":1507.17,"body":"that I've seen over and over."},{"speaker":"Charles Goldfarb","startTime":1502.34,"endTime":1507.17,"body":"Meaning it's, there's not a, for"},{"speaker":"Charles Goldfarb","startTime":1507.17,"endTime":1510.59,"body":"example, it's not always central"},{"speaker":"Charles Goldfarb","startTime":1507.17,"endTime":1510.59,"body":"tears or, or volar, or dorsal"},{"speaker":"Charles Goldfarb","startTime":1510.59,"endTime":1513.86,"body":"tears or foveal tears, it can be"},{"speaker":"Charles Goldfarb","startTime":1510.59,"endTime":1513.86,"body":"pretty much anything. And often"},{"speaker":"Charles Goldfarb","startTime":1513.86,"endTime":1516.08,"body":"it's an inflammatory issue,"},{"speaker":"Charles Goldfarb","startTime":1513.86,"endTime":1516.08,"body":"right, a lot of synovitis"},{"speaker":"Charles Goldfarb","startTime":1516.08,"endTime":1519.98,"body":"develops and, and there may not"},{"speaker":"Charles Goldfarb","startTime":1516.08,"endTime":1519.98,"body":"be a prominent tear. But you"},{"speaker":"Charles Goldfarb","startTime":1519.98,"endTime":1522.95,"body":"know, I start with DREJ"},{"speaker":"Charles Goldfarb","startTime":1519.98,"endTime":1522.95,"body":"examination to make sure the"},{"speaker":"Charles Goldfarb","startTime":1522.95,"endTime":1528.17,"body":"DREJ is stable. Check for foveal"},{"speaker":"Charles Goldfarb","startTime":1522.95,"endTime":1528.17,"body":"discomfort. And these are"},{"speaker":"Charles Goldfarb","startTime":1528.17,"endTime":1532.79,"body":"patients that if I really think"},{"speaker":"Charles Goldfarb","startTime":1528.17,"endTime":1532.79,"body":"it is there's a stable DREJ and"},{"speaker":"Charles Goldfarb","startTime":1532.79,"endTime":1536.45,"body":"focal discomfort, I don't mind"},{"speaker":"Charles Goldfarb","startTime":1532.79,"endTime":1536.45,"body":"doing a steroid injection as a"},{"speaker":"Charles Goldfarb","startTime":1536.45,"endTime":1540.08,"body":"one time intervention for both"},{"speaker":"Charles Goldfarb","startTime":1536.45,"endTime":1540.08,"body":"diagnostic and therapeutic"},{"speaker":"Charles Goldfarb","startTime":1540.08,"endTime":1542.63,"body":"purposes, and see what happens."},{"speaker":"Charles Goldfarb","startTime":1540.08,"endTime":1542.63,"body":"And I've been happy that"},{"speaker":"Charles Goldfarb","startTime":1542.63,"endTime":1545.15,"body":"sometimes you know, you treat it"},{"speaker":"Charles Goldfarb","startTime":1542.63,"endTime":1545.15,"body":"and patients don't come back."},{"speaker":"Chris Dy","startTime":1545.869,"endTime":1549.619,"body":"And are you typically,"},{"speaker":"Chris Dy","startTime":1545.869,"endTime":1549.619,"body":"what's your threshold for say"},{"speaker":"Chris Dy","startTime":1549.619,"endTime":1553.819,"body":"you've done, you know, therapy,"},{"speaker":"Chris Dy","startTime":1549.619,"endTime":1553.819,"body":"different types of supports"},{"speaker":"Chris Dy","startTime":1553.819,"endTime":1556.489,"body":"braces orthosis, and you've"},{"speaker":"Chris Dy","startTime":1553.819,"endTime":1556.489,"body":"tried an injection, what's your"},{"speaker":"Chris Dy","startTime":1556.489,"endTime":1557.839,"body":"threshold to go to surgery?"},{"speaker":"Charles Goldfarb","startTime":1559.28,"endTime":1561.89,"body":"Again, it's"},{"speaker":"Charles Goldfarb","startTime":1559.28,"endTime":1561.89,"body":"all about the athlete and the"},{"speaker":"Charles Goldfarb","startTime":1561.89,"endTime":1568.22,"body":"family if it's a younger patient"},{"speaker":"Charles Goldfarb","startTime":1561.89,"endTime":1568.22,"body":"and their patients. And I'm not"},{"speaker":"Charles Goldfarb","startTime":1568.22,"endTime":1571.88,"body":"one who preaches patients beyond"},{"speaker":"Charles Goldfarb","startTime":1568.22,"endTime":1571.88,"body":"reason, you know, we need to be,"},{"speaker":"Charles Goldfarb","startTime":1572.18,"endTime":1575.51,"body":"I feel like we as physicians"},{"speaker":"Charles Goldfarb","startTime":1572.18,"endTime":1575.51,"body":"need to understand priorities."},{"speaker":"Charles Goldfarb","startTime":1575.51,"endTime":1579.11,"body":"And so if I have immobilized for"},{"speaker":"Charles Goldfarb","startTime":1575.51,"endTime":1579.11,"body":"six weeks, which I will do with"},{"speaker":"Charles Goldfarb","startTime":1579.11,"endTime":1583.19,"body":"an acute event, concert with"},{"speaker":"Charles Goldfarb","startTime":1579.11,"endTime":1583.19,"body":"concern for TFCC, if I have done"},{"speaker":"Charles Goldfarb","startTime":1583.19,"endTime":1585.95,"body":"anti inflammatories and some"},{"speaker":"Charles Goldfarb","startTime":1583.19,"endTime":1585.95,"body":"therapy to try to calm things"},{"speaker":"Charles Goldfarb","startTime":1585.95,"endTime":1589.34,"body":"down, if I have done a steroid"},{"speaker":"Charles Goldfarb","startTime":1585.95,"endTime":1589.34,"body":"injection with temporary"},{"speaker":"Charles Goldfarb","startTime":1589.34,"endTime":1594.62,"body":"improvement, but recurrence, I'm"},{"speaker":"Charles Goldfarb","startTime":1589.34,"endTime":1594.62,"body":"offering arthroscopic assessment"},{"speaker":"Charles Goldfarb","startTime":1594.62,"endTime":1595.7,"body":"at that point in agreement."},{"speaker":"Chris Dy","startTime":1596.32,"endTime":1599.47,"body":"So you mentioned"},{"speaker":"Chris Dy","startTime":1596.32,"endTime":1599.47,"body":"immobilization is that the true"},{"speaker":"Chris Dy","startTime":1599.47,"endTime":1605.11,"body":"old school above elbow kind of"},{"speaker":"Chris Dy","startTime":1599.47,"endTime":1605.11,"body":"monster situation? Or are you"},{"speaker":"Chris Dy","startTime":1605.11,"endTime":1609.31,"body":"more kind and perhaps allowing a"},{"speaker":"Chris Dy","startTime":1605.11,"endTime":1609.31,"body":"little motion at that TFCC and"},{"speaker":"Chris Dy","startTime":1609.31,"endTime":1610.27,"body":"staying below the elbow?"},{"speaker":"Charles Goldfarb","startTime":1610.9,"endTime":1614.02,"body":"If someone"},{"speaker":"Charles Goldfarb","startTime":1610.9,"endTime":1614.02,"body":"walks in the office that has"},{"speaker":"Charles Goldfarb","startTime":1614.02,"endTime":1620.17,"body":"what I believe is an acute TFCC"},{"speaker":"Charles Goldfarb","startTime":1614.02,"endTime":1620.17,"body":"tear, focal pain, perhaps a"},{"speaker":"Charles Goldfarb","startTime":1620.17,"endTime":1624.55,"body":"suggestion of instability, or an"},{"speaker":"Charles Goldfarb","startTime":1620.17,"endTime":1624.55,"body":"MRI that shows the finding, I"},{"speaker":"Charles Goldfarb","startTime":1624.55,"endTime":1629.23,"body":"will put it above elbow cast and"},{"speaker":"Charles Goldfarb","startTime":1624.55,"endTime":1629.23,"body":"neutral rotation. However, that"},{"speaker":"Charles Goldfarb","startTime":1629.23,"endTime":1632.59,"body":"doesn't happen. It just doesn't"},{"speaker":"Charles Goldfarb","startTime":1629.23,"endTime":1632.59,"body":"happen. You don't see patients"},{"speaker":"Charles Goldfarb","startTime":1632.59,"endTime":1636.49,"body":"acutely, almost ever, but if"},{"speaker":"Charles Goldfarb","startTime":1632.59,"endTime":1636.49,"body":"they do, then that's what I push"},{"speaker":"Charles Goldfarb","startTime":1636.49,"endTime":1637.06,"body":"for sure."},{"speaker":"Chris Dy","startTime":1637.3,"endTime":1639.43,"body":"How long do they you"},{"speaker":"Chris Dy","startTime":1637.3,"endTime":1639.43,"body":"have them wear that for four"},{"speaker":"Chris Dy","startTime":1639.43,"endTime":1640.27,"body":"weeks? Six weeks?"},{"speaker":"Charles Goldfarb","startTime":1640.51,"endTime":1641.8,"body":"Six weeks,"},{"speaker":"Charles Goldfarb","startTime":1640.51,"endTime":1641.8,"body":"Munster."},{"speaker":"Chris Dy","startTime":1642.22,"endTime":1643.78,"body":"How much do they hate"},{"speaker":"Chris Dy","startTime":1642.22,"endTime":1643.78,"body":"you at six weeks?"},{"speaker":"Charles Goldfarb","startTime":1644.41,"endTime":1645.91,"body":"They liked me"},{"speaker":"Charles Goldfarb","startTime":1644.41,"endTime":1645.91,"body":"because I take it off."},{"speaker":"Chris Dy","startTime":1646.75,"endTime":1648.4,"body":"That's right, that's"},{"speaker":"Chris Dy","startTime":1646.75,"endTime":1648.4,"body":"right. We've mentioned this in"},{"speaker":"Chris Dy","startTime":1648.4,"endTime":1653.65,"body":"the past podcast. And then round"},{"speaker":"Chris Dy","startTime":1648.4,"endTime":1653.65,"body":"us out with the ECU. I think"},{"speaker":"Chris Dy","startTime":1653.65,"endTime":1657.01,"body":"this is something that is"},{"speaker":"Chris Dy","startTime":1653.65,"endTime":1657.01,"body":"somewhat sometimes nebulous to"},{"speaker":"Chris Dy","startTime":1657.01,"endTime":1661.21,"body":"diagnose. So tell us how you how"},{"speaker":"Chris Dy","startTime":1657.01,"endTime":1661.21,"body":"you evaluate that patient."},{"speaker":"Charles Goldfarb","startTime":1662.14,"endTime":1665.59,"body":"I would say"},{"speaker":"Charles Goldfarb","startTime":1662.14,"endTime":1665.59,"body":"ECU instability happens for"},{"speaker":"Charles Goldfarb","startTime":1665.59,"endTime":1669.52,"body":"sure. And it's one of those"},{"speaker":"Charles Goldfarb","startTime":1665.59,"endTime":1669.52,"body":"things that some people would"},{"speaker":"Charles Goldfarb","startTime":1669.52,"endTime":1673.42,"body":"tell you well, you know, you can"},{"speaker":"Charles Goldfarb","startTime":1669.52,"endTime":1673.42,"body":"have an unstable ECU and it's"},{"speaker":"Charles Goldfarb","startTime":1673.42,"endTime":1675.7,"body":"not a problem. Well, it's a"},{"speaker":"Charles Goldfarb","startTime":1673.42,"endTime":1675.7,"body":"problem if the patient's coming"},{"speaker":"Charles Goldfarb","startTime":1675.7,"endTime":1679.39,"body":"in for it. If it's a problem"},{"speaker":"Charles Goldfarb","startTime":1675.7,"endTime":1679.39,"body":"that this snapping is painful,"},{"speaker":"Charles Goldfarb","startTime":1680.41,"endTime":1683.65,"body":"and so making that diagnosis"},{"speaker":"Charles Goldfarb","startTime":1680.41,"endTime":1683.65,"body":"usually is not that tough, but"},{"speaker":"Charles Goldfarb","startTime":1683.65,"endTime":1687.7,"body":"the classic is the patient will"},{"speaker":"Charles Goldfarb","startTime":1683.65,"endTime":1687.7,"body":"come in with their with the form"},{"speaker":"Charles Goldfarb","startTime":1687.7,"endTime":1691.99,"body":"and pronation the wrist extended"},{"speaker":"Charles Goldfarb","startTime":1687.7,"endTime":1691.99,"body":"and they're happy. And if you"},{"speaker":"Charles Goldfarb","startTime":1692.02,"endTime":1696.85,"body":"like the ice cream scoop"},{"speaker":"Charles Goldfarb","startTime":1692.02,"endTime":1696.85,"body":"maneuver, then that ECU become"},{"speaker":"Charles Goldfarb","startTime":1696.85,"endTime":1702.37,"body":"unstable and we'll pop again, in"},{"speaker":"Charles Goldfarb","startTime":1696.85,"endTime":1702.37,"body":"an acute setting with an acute"},{"speaker":"Charles Goldfarb","startTime":1702.37,"endTime":1706.27,"body":"tear of the ECU sub sheath,"},{"speaker":"Charles Goldfarb","startTime":1702.37,"endTime":1706.27,"body":"which does happen. Repair makes"},{"speaker":"Charles Goldfarb","startTime":1706.27,"endTime":1711.1,"body":"sense. You could also argue that"},{"speaker":"Charles Goldfarb","startTime":1706.27,"endTime":1711.1,"body":"casting in a pronated extended"},{"speaker":"Charles Goldfarb","startTime":1711.4,"endTime":1715.06,"body":"position makes sense that would"},{"speaker":"Charles Goldfarb","startTime":1711.4,"endTime":1715.06,"body":"be a munster as well. But in"},{"speaker":"Charles Goldfarb","startTime":1715.06,"endTime":1717.82,"body":"high level athlete, it would be"},{"speaker":"Charles Goldfarb","startTime":1715.06,"endTime":1717.82,"body":"an acute repair. Most of the"},{"speaker":"Charles Goldfarb","startTime":1717.82,"endTime":1720.46,"body":"time, these are a little more"},{"speaker":"Charles Goldfarb","startTime":1717.82,"endTime":1720.46,"body":"chronic diagnosis isn't an"},{"speaker":"Charles Goldfarb","startTime":1720.46,"endTime":1724.69,"body":"issue. And in those patients."},{"speaker":"Charles Goldfarb","startTime":1720.46,"endTime":1724.69,"body":"I'm a strong believer in"},{"speaker":"Charles Goldfarb","startTime":1724.69,"endTime":1727.57,"body":"transposing the ECU more"},{"speaker":"Charles Goldfarb","startTime":1724.69,"endTime":1727.57,"body":"dorsally although a lot of what"},{"speaker":"Charles Goldfarb","startTime":1727.57,"endTime":1730.03,"body":"you'll read talks about"},{"speaker":"Charles Goldfarb","startTime":1727.57,"endTime":1730.03,"body":"reconstructing the sheath or"},{"speaker":"Charles Goldfarb","startTime":1730.03,"endTime":1732.91,"body":"deepening the groove that just"},{"speaker":"Charles Goldfarb","startTime":1730.03,"endTime":1732.91,"body":"has never worked particularly"},{"speaker":"Charles Goldfarb","startTime":1732.91,"endTime":1735.13,"body":"well or made sense to me and"},{"speaker":"Charles Goldfarb","startTime":1732.91,"endTime":1735.13,"body":"we've shared our results which"},{"speaker":"Charles Goldfarb","startTime":1735.13,"endTime":1735.76,"body":"are pretty good."},{"speaker":"Chris Dy","startTime":1736.93,"endTime":1739.03,"body":"How do you think about"},{"speaker":"Chris Dy","startTime":1736.93,"endTime":1739.03,"body":"this in batters? Is it different"},{"speaker":"Chris Dy","startTime":1739.03,"endTime":1742.06,"body":"is ECU, are ECU issues in"},{"speaker":"Chris Dy","startTime":1739.03,"endTime":1742.06,"body":"batters different than general"},{"speaker":"Chris Dy","startTime":1742.06,"endTime":1746.02,"body":"population? Joe Schmo, Jane"},{"speaker":"Chris Dy","startTime":1742.06,"endTime":1746.02,"body":"Schmo ECUs."},{"speaker":"Charles Goldfarb","startTime":1746.23,"endTime":1748.57,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":1746.23,"endTime":1748.57,"body":"think it's just the forces they"},{"speaker":"Charles Goldfarb","startTime":1748.57,"endTime":1752.5,"body":"put on their wrist and you can"},{"speaker":"Charles Goldfarb","startTime":1748.57,"endTime":1752.5,"body":"see the batters that make it"},{"speaker":"Charles Goldfarb","startTime":1752.5,"endTime":1757.75,"body":"look easy and smooth. And you"},{"speaker":"Charles Goldfarb","startTime":1752.5,"endTime":1757.75,"body":"can see batters who just the"},{"speaker":"Charles Goldfarb","startTime":1757.75,"endTime":1764.44,"body":"forces that go across that wrist"},{"speaker":"Charles Goldfarb","startTime":1757.75,"endTime":1764.44,"body":"are incredible. And so I don't"},{"speaker":"Charles Goldfarb","startTime":1764.44,"endTime":1769.93,"body":"think it's any different is just"},{"speaker":"Charles Goldfarb","startTime":1764.44,"endTime":1769.93,"body":"kind of how they get there. And"},{"speaker":"Charles Goldfarb","startTime":1770.44,"endTime":1773.8,"body":"either have the uns- in my mind"},{"speaker":"Charles Goldfarb","startTime":1770.44,"endTime":1773.8,"body":"is very simple. You have an"},{"speaker":"Charles Goldfarb","startTime":1773.8,"endTime":1778.39,"body":"unstable ECU tenant, or you have"},{"speaker":"Charles Goldfarb","startTime":1773.8,"endTime":1778.39,"body":"ECU irritability, ECU"},{"speaker":"Charles Goldfarb","startTime":1778.42,"endTime":1781.84,"body":"tendinitis, so to speak."},{"speaker":"Charles Goldfarb","startTime":1778.42,"endTime":1781.84,"body":"Checkmate can be a little more"},{"speaker":"Charles Goldfarb","startTime":1781.84,"endTime":1784.57,"body":"difficult to diagnosis and it"},{"speaker":"Charles Goldfarb","startTime":1781.84,"endTime":1784.57,"body":"can be a little more difficult"},{"speaker":"Charles Goldfarb","startTime":1784.84,"endTime":1788.77,"body":"to treat. But ultimately, it's a"},{"speaker":"Charles Goldfarb","startTime":1784.84,"endTime":1788.77,"body":"mobilization anti inflammatories"},{"speaker":"Charles Goldfarb","startTime":1788.77,"endTime":1792.34,"body":"plus minus one and one only"},{"speaker":"Charles Goldfarb","startTime":1788.77,"endTime":1792.34,"body":"steroid injection that location"},{"speaker":"Charles Goldfarb","startTime":1792.46,"endTime":1792.94,"body":"for me."},{"speaker":"Chris Dy","startTime":1793.78,"endTime":1796.33,"body":"Obviously, the risk"},{"speaker":"Chris Dy","startTime":1793.78,"endTime":1796.33,"body":"with a steroid injection is a"},{"speaker":"Chris Dy","startTime":1796.48,"endTime":1800.2,"body":"rupture of the ECU and that"},{"speaker":"Chris Dy","startTime":1796.48,"endTime":1800.2,"body":"would not be good because"},{"speaker":"Chris Dy","startTime":1800.2,"endTime":1802.9,"body":"because obviously how powerful"},{"speaker":"Chris Dy","startTime":1800.2,"endTime":1802.9,"body":"the force that is, and the point"},{"speaker":"Chris Dy","startTime":1802.9,"endTime":1807.43,"body":"that this patient in particular"},{"speaker":"Chris Dy","startTime":1802.9,"endTime":1807.43,"body":"really needs on their deviation"},{"speaker":"Chris Dy","startTime":1807.46,"endTime":1812.29,"body":"as the many of us, but what are"},{"speaker":"Chris Dy","startTime":1807.46,"endTime":1812.29,"body":"your pearls for injection? If"},{"speaker":"Chris Dy","startTime":1812.29,"endTime":1813.37,"body":"one were to try this?"},{"speaker":"Charles Goldfarb","startTime":1814.12,"endTime":1816.79,"body":"So I,"},{"speaker":"Charles Goldfarb","startTime":1814.12,"endTime":1816.79,"body":"thankfully knock on wood, I've"},{"speaker":"Charles Goldfarb","startTime":1816.79,"endTime":1820.36,"body":"never had a rupture, which"},{"speaker":"Charles Goldfarb","startTime":1816.79,"endTime":1820.36,"body":"you'll see in patients, this is"},{"speaker":"Charles Goldfarb","startTime":1820.36,"endTime":1823.9,"body":"probably the worst area in the"},{"speaker":"Charles Goldfarb","startTime":1820.36,"endTime":1823.9,"body":"body. And you You certainly have"},{"speaker":"Charles Goldfarb","startTime":1823.9,"endTime":1827.62,"body":"an opinion on this. But I think"},{"speaker":"Charles Goldfarb","startTime":1823.9,"endTime":1827.62,"body":"the subcutaneous fat atrophy in"},{"speaker":"Charles Goldfarb","startTime":1827.62,"endTime":1831.19,"body":"this location, is riskiest, for"},{"speaker":"Charles Goldfarb","startTime":1827.62,"endTime":1831.19,"body":"whatever reason, certainly, you"},{"speaker":"Charles Goldfarb","startTime":1831.19,"endTime":1833.77,"body":"can see it me too. You can see"},{"speaker":"Charles Goldfarb","startTime":1831.19,"endTime":1833.77,"body":"it regularly at the first"},{"speaker":"Charles Goldfarb","startTime":1833.77,"endTime":1837.19,"body":"compartment, you can see it over"},{"speaker":"Charles Goldfarb","startTime":1833.77,"endTime":1837.19,"body":"the ECRB origin for tennis"},{"speaker":"Charles Goldfarb","startTime":1837.19,"endTime":1841.15,"body":"elbow, but for me, this is the"},{"speaker":"Charles Goldfarb","startTime":1837.19,"endTime":1841.15,"body":"area that has little tolerance."},{"speaker":"Charles Goldfarb","startTime":1841.15,"endTime":1844.54,"body":"That's one of the reasons a"},{"speaker":"Charles Goldfarb","startTime":1841.15,"endTime":1844.54,"body":"single injection is all out"},{"speaker":"Charles Goldfarb","startTime":1844.6,"endTime":1850.09,"body":"typically do. I inject about a"},{"speaker":"Charles Goldfarb","startTime":1844.6,"endTime":1850.09,"body":"centimeter proximal to the DREJ,"},{"speaker":"Charles Goldfarb","startTime":1850.27,"endTime":1853.39,"body":"I don't want any diagnostic"},{"speaker":"Charles Goldfarb","startTime":1850.27,"endTime":1853.39,"body":"confusion. So if I'm giving an"},{"speaker":"Charles Goldfarb","startTime":1853.39,"endTime":1856.3,"body":"ECU injection, I want to know"},{"speaker":"Charles Goldfarb","startTime":1853.39,"endTime":1856.3,"body":"that it worked at least"},{"speaker":"Charles Goldfarb","startTime":1856.3,"endTime":1860.02,"body":"temporarily helps me confirm"},{"speaker":"Charles Goldfarb","startTime":1856.3,"endTime":1860.02,"body":"that this is ECU problems and"},{"speaker":"Charles Goldfarb","startTime":1860.02,"endTime":1864.28,"body":"not something else. And I"},{"speaker":"Charles Goldfarb","startTime":1860.02,"endTime":1864.28,"body":"typically obviously don't want"},{"speaker":"Charles Goldfarb","startTime":1864.28,"endTime":1868.03,"body":"to inject into the tenant, I"},{"speaker":"Charles Goldfarb","startTime":1864.28,"endTime":1868.03,"body":"eject adjacent to the tenant and"},{"speaker":"Charles Goldfarb","startTime":1868.03,"endTime":1870.64,"body":"use the ulna, the dorsal ulna as"},{"speaker":"Charles Goldfarb","startTime":1868.03,"endTime":1870.64,"body":"kind of a landmark."},{"speaker":"Chris Dy","startTime":1871.42,"endTime":1874.78,"body":"When you're inserting"},{"speaker":"Chris Dy","startTime":1871.42,"endTime":1874.78,"body":"your needle, how do you know"},{"speaker":"Chris Dy","startTime":1874.78,"endTime":1878.77,"body":"that you're at the right depth?"},{"speaker":"Chris Dy","startTime":1874.78,"endTime":1878.77,"body":"Are you feeling tendon walking?"},{"speaker":"Chris Dy","startTime":1878.8,"endTime":1882.4,"body":"And then kind of pulling back?"},{"speaker":"Chris Dy","startTime":1878.8,"endTime":1882.4,"body":"Are you kind of adept enough now"},{"speaker":"Chris Dy","startTime":1882.4,"endTime":1884.62,"body":"with knowing kind of layers"},{"speaker":"Chris Dy","startTime":1882.4,"endTime":1884.62,"body":"you're working through before"},{"speaker":"Chris Dy","startTime":1884.62,"endTime":1885.49,"body":"you get to the tendon?"},{"speaker":"Charles Goldfarb","startTime":1885.76,"endTime":1887.83,"body":"Well, I'm not."},{"speaker":"Charles Goldfarb","startTime":1885.76,"endTime":1887.83,"body":"I'm not an old stone guy. But"},{"speaker":"Charles Goldfarb","startTime":1887.83,"endTime":1890.92,"body":"certainly this is an area where"},{"speaker":"Charles Goldfarb","startTime":1887.83,"endTime":1890.92,"body":"ultrasound could be helpful. I"},{"speaker":"Charles Goldfarb","startTime":1890.92,"endTime":1893.23,"body":"think you are, you know,"},{"speaker":"Charles Goldfarb","startTime":1890.92,"endTime":1893.23,"body":"thankfully, it's not very hard"},{"speaker":"Charles Goldfarb","startTime":1893.23,"endTime":1896.59,"body":"to palpate, typically. So you"},{"speaker":"Charles Goldfarb","startTime":1893.23,"endTime":1896.59,"body":"can palpate, the ECU, and I"},{"speaker":"Charles Goldfarb","startTime":1896.59,"endTime":1900.46,"body":"usually use the bone as my as my"},{"speaker":"Charles Goldfarb","startTime":1896.59,"endTime":1900.46,"body":"landmark. I'm not going down"},{"speaker":"Charles Goldfarb","startTime":1900.46,"endTime":1903.82,"body":"trying to stab the bone because"},{"speaker":"Charles Goldfarb","startTime":1900.46,"endTime":1903.82,"body":"I think that's cool, but aiming"},{"speaker":"Charles Goldfarb","startTime":1903.82,"endTime":1907.24,"body":"for the tendon, usually going"},{"speaker":"Charles Goldfarb","startTime":1903.82,"endTime":1907.24,"body":"just beneath it and injecting"},{"speaker":"Charles Goldfarb","startTime":1907.24,"endTime":1908.89,"body":"there. How do you do it?"},{"speaker":"Chris Dy","startTime":1909.91,"endTime":1912.58,"body":"Pretty similarly, I've"},{"speaker":"Chris Dy","startTime":1909.91,"endTime":1912.58,"body":"only had to inject a few. You"},{"speaker":"Chris Dy","startTime":1912.58,"endTime":1915.76,"body":"know, I think at this point,"},{"speaker":"Chris Dy","startTime":1912.58,"endTime":1915.76,"body":"honestly, I would use ultrasound"},{"speaker":"Chris Dy","startTime":1915.82,"endTime":1918.46,"body":"either I would do it myself with"},{"speaker":"Chris Dy","startTime":1915.82,"endTime":1918.46,"body":"ultrasound. If I felt confident"},{"speaker":"Chris Dy","startTime":1918.46,"endTime":1920.62,"body":"with that. Or if the anatomy was"},{"speaker":"Chris Dy","startTime":1918.46,"endTime":1920.62,"body":"more challenging, I would I"},{"speaker":"Chris Dy","startTime":1920.62,"endTime":1923.2,"body":"would send it to one of our"},{"speaker":"Chris Dy","startTime":1920.62,"endTime":1923.2,"body":"partners for ultrasound. It's"},{"speaker":"Chris Dy","startTime":1923.2,"endTime":1925.57,"body":"super convenient to have the"},{"speaker":"Chris Dy","startTime":1923.2,"endTime":1925.57,"body":"ultrasound in the clinic, but"},{"speaker":"Chris Dy","startTime":1925.57,"endTime":1928.84,"body":"also to have our physiatry"},{"speaker":"Chris Dy","startTime":1925.57,"endTime":1928.84,"body":"partners who are so good with"},{"speaker":"Chris Dy","startTime":1928.84,"endTime":1931.75,"body":"the ultrasound to I've learned"},{"speaker":"Chris Dy","startTime":1928.84,"endTime":1931.75,"body":"so much just watching them scan"},{"speaker":"Chris Dy","startTime":1931.75,"endTime":1932.02,"body":"too."},{"speaker":"Charles Goldfarb","startTime":1932.5,"endTime":1936.01,"body":"Yeah, I have"},{"speaker":"Charles Goldfarb","startTime":1932.5,"endTime":1936.01,"body":"no doubt. So, you know, I think"},{"speaker":"Charles Goldfarb","startTime":1936.01,"endTime":1940.48,"body":"baseball is a fun sport to be"},{"speaker":"Charles Goldfarb","startTime":1936.01,"endTime":1940.48,"body":"involved with. Certainly hand"},{"speaker":"Charles Goldfarb","startTime":1940.48,"endTime":1943.36,"body":"surgeons have a role. Some of"},{"speaker":"Charles Goldfarb","startTime":1940.48,"endTime":1943.36,"body":"it's really silly, you know,"},{"speaker":"Charles Goldfarb","startTime":1943.36,"endTime":1947.71,"body":"when a pitcher gets a blister,"},{"speaker":"Charles Goldfarb","startTime":1943.36,"endTime":1947.71,"body":"that's a major problem. But"},{"speaker":"Charles Goldfarb","startTime":1947.71,"endTime":1950.11,"body":"there's all kinds of hand and"},{"speaker":"Charles Goldfarb","startTime":1947.71,"endTime":1950.11,"body":"wrist and forearm issues in"},{"speaker":"Charles Goldfarb","startTime":1950.11,"endTime":1953.41,"body":"baseball, which I think can be"},{"speaker":"Charles Goldfarb","startTime":1950.11,"endTime":1953.41,"body":"very fun. And certainly we can"},{"speaker":"Charles Goldfarb","startTime":1953.41,"endTime":1956.02,"body":"dive deeper in some other areas,"},{"speaker":"Charles Goldfarb","startTime":1953.41,"endTime":1956.02,"body":"like I said, maybe have a guest"},{"speaker":"Charles Goldfarb","startTime":1956.02,"endTime":1957.55,"body":"on to talk UCL at some point."},{"speaker":"Chris Dy","startTime":1957.94,"endTime":1960.25,"body":"I think that'd be"},{"speaker":"Chris Dy","startTime":1957.94,"endTime":1960.25,"body":"great. Now remember, the thing"},{"speaker":"Chris Dy","startTime":1960.25,"endTime":1963.25,"body":"that we're doing this season is"},{"speaker":"Chris Dy","startTime":1960.25,"endTime":1963.25,"body":"that we're closing with one win."},{"speaker":"Chris Dy","startTime":1963.79,"endTime":1966.88,"body":"So can you do you want to share"},{"speaker":"Chris Dy","startTime":1963.79,"endTime":1966.88,"body":"a win that you have? Or should I"},{"speaker":"Chris Dy","startTime":1966.88,"endTime":1967.51,"body":"go first?"},{"speaker":"Charles Goldfarb","startTime":1967.87,"endTime":1969.52,"body":"I have one but"},{"speaker":"Charles Goldfarb","startTime":1967.87,"endTime":1969.52,"body":"you go first."},{"speaker":"Chris Dy","startTime":1970.18,"endTime":1972.67,"body":"Uh, you know, we got"},{"speaker":"Chris Dy","startTime":1970.18,"endTime":1972.67,"body":"to see the brachial plexus and"},{"speaker":"Chris Dy","startTime":1972.67,"endTime":1975.55,"body":"all of its glory this morning."},{"speaker":"Chris Dy","startTime":1972.67,"endTime":1975.55,"body":"And that, to me is a huge one."},{"speaker":"Chris Dy","startTime":1975.82,"endTime":1979.21,"body":"Honestly, the opportunity to"},{"speaker":"Chris Dy","startTime":1975.82,"endTime":1979.21,"body":"have the, you know, the"},{"speaker":"Chris Dy","startTime":1979.21,"endTime":1982.03,"body":"categoric specimens to do that"},{"speaker":"Chris Dy","startTime":1979.21,"endTime":1982.03,"body":"it is honestly one of the things"},{"speaker":"Chris Dy","startTime":1982.03,"endTime":1984.91,"body":"I love the most, during the"},{"speaker":"Chris Dy","startTime":1982.03,"endTime":1984.91,"body":"academic year is getting to do"},{"speaker":"Chris Dy","startTime":1984.91,"endTime":1988.39,"body":"this lab and hearing our"},{"speaker":"Chris Dy","startTime":1984.91,"endTime":1988.39,"body":"trainees, maybe they're just"},{"speaker":"Chris Dy","startTime":1988.39,"endTime":1990.58,"body":"saying it for me, but they"},{"speaker":"Chris Dy","startTime":1988.39,"endTime":1990.58,"body":"really appreciated it. And I"},{"speaker":"Chris Dy","startTime":1990.58,"endTime":1992.8,"body":"know they did. So that was a big"},{"speaker":"Chris Dy","startTime":1990.58,"endTime":1992.8,"body":"one for me."},{"speaker":"Charles Goldfarb","startTime":1992.0,"endTime":1995.66,"body":"And that is"},{"speaker":"Charles Goldfarb","startTime":1992.0,"endTime":1995.66,"body":"why is a beautiful thing that we"},{"speaker":"Charles Goldfarb","startTime":1995.66,"endTime":1998.72,"body":"are partners, because looking at"},{"speaker":"Charles Goldfarb","startTime":1995.66,"endTime":1998.72,"body":"that brachial plexus just brings"},{"speaker":"Charles Goldfarb","startTime":1998.72,"endTime":2005.89,"body":"flashbacks, my wind is the"},{"speaker":"Charles Goldfarb","startTime":1998.72,"endTime":2005.89,"body":"receding nature of omicron. And"},{"speaker":"Charles Goldfarb","startTime":2005.89,"endTime":2012.1,"body":"the fact that optimism is is is"},{"speaker":"Charles Goldfarb","startTime":2005.89,"endTime":2012.1,"body":"here. And as the weather warms"},{"speaker":"Charles Goldfarb","startTime":2012.1,"endTime":2015.1,"body":"up, I think those two factors"},{"speaker":"Charles Goldfarb","startTime":2012.1,"endTime":2015.1,"body":"together, especially if we don't"},{"speaker":"Charles Goldfarb","startTime":2015.1,"endTime":2017.89,"body":"get hit with another wave, but"},{"speaker":"Charles Goldfarb","startTime":2015.1,"endTime":2017.89,"body":"something really feels good."},{"speaker":"Charles Goldfarb","startTime":2017.89,"endTime":2020.62,"body":"There's just so much going on"},{"speaker":"Charles Goldfarb","startTime":2017.89,"endTime":2020.62,"body":"right now. And so many"},{"speaker":"Charles Goldfarb","startTime":2020.62,"endTime":2024.31,"body":"challenges that this feels like"},{"speaker":"Charles Goldfarb","startTime":2020.62,"endTime":2024.31,"body":"a really big directionality"},{"speaker":"Charles Goldfarb","startTime":2024.31,"endTime":2027.88,"body":"change. I went to my wife as an"},{"speaker":"Charles Goldfarb","startTime":2024.31,"endTime":2027.88,"body":"entrepreneur, and we went to"},{"speaker":"Charles Goldfarb","startTime":2028.33,"endTime":2033.67,"body":"dinner to support budding"},{"speaker":"Charles Goldfarb","startTime":2028.33,"endTime":2033.67,"body":"entrepreneurs. And you know, we"},{"speaker":"Charles Goldfarb","startTime":2033.67,"endTime":2037.3,"body":"had our mask on and we knocked"},{"speaker":"Charles Goldfarb","startTime":2033.67,"endTime":2037.3,"body":"on the door, you know,"},{"speaker":"Charles Goldfarb","startTime":2037.33,"endTime":2040.66,"body":"relatively small group and"},{"speaker":"Charles Goldfarb","startTime":2037.33,"endTime":2040.66,"body":"walked in there was not a single"},{"speaker":"Charles Goldfarb","startTime":2040.66,"endTime":2044.29,"body":"mass to be seen. You know, I had"},{"speaker":"Charles Goldfarb","startTime":2040.66,"endTime":2044.29,"body":"a moment of panic. And then we"},{"speaker":"Charles Goldfarb","startTime":2044.29,"endTime":2047.68,"body":"took off her mask. And you know,"},{"speaker":"Charles Goldfarb","startTime":2044.29,"endTime":2047.68,"body":"few days later, we're fine."},{"speaker":"Chris Dy","startTime":2048.7,"endTime":2051.19,"body":"Okay, I'll see you."},{"speaker":"Chris Dy","startTime":2048.7,"endTime":2051.19,"body":"Maybe I won't see you at work"},{"speaker":"Chris Dy","startTime":2051.19,"endTime":2055.27,"body":"this week. But okay. Yeah, I"},{"speaker":"Chris Dy","startTime":2051.19,"endTime":2055.27,"body":"think what's one thing that's"},{"speaker":"Chris Dy","startTime":2055.27,"endTime":2059.08,"body":"interesting about Omicron and"},{"speaker":"Chris Dy","startTime":2055.27,"endTime":2059.08,"body":"COVID, in general, is that you"},{"speaker":"Chris Dy","startTime":2059.08,"endTime":2062.68,"body":"really see people's individual"},{"speaker":"Chris Dy","startTime":2059.08,"endTime":2062.68,"body":"appetites for risk. And I don't"},{"speaker":"Chris Dy","startTime":2062.68,"endTime":2065.17,"body":"say that in a negative way. I"},{"speaker":"Chris Dy","startTime":2062.68,"endTime":2065.17,"body":"just say that in a very kind of"},{"speaker":"Chris Dy","startTime":2065.35,"endTime":2068.29,"body":"factual way. Like everybody's"},{"speaker":"Chris Dy","startTime":2065.35,"endTime":2068.29,"body":"got their own calculus of who"},{"speaker":"Chris Dy","startTime":2068.29,"endTime":2070.87,"body":"they're willing to hang out"},{"speaker":"Chris Dy","startTime":2068.29,"endTime":2070.87,"body":"with, and in which capacity and"},{"speaker":"Chris Dy","startTime":2071.86,"endTime":2073.21,"body":"it's very interesting."},{"speaker":"Charles Goldfarb","startTime":2074.26,"endTime":2077.08,"body":"Yes, it's very"},{"speaker":"Charles Goldfarb","startTime":2074.26,"endTime":2077.08,"body":"interesting. And you factor in"},{"speaker":"Charles Goldfarb","startTime":2077.08,"endTime":2080.47,"body":"mental health. I mean, there's"},{"speaker":"Charles Goldfarb","startTime":2077.08,"endTime":2080.47,"body":"so this is really an interesting"},{"speaker":"Charles Goldfarb","startTime":2080.47,"endTime":2083.35,"body":"time. It's good to live in"},{"speaker":"Charles Goldfarb","startTime":2080.47,"endTime":2083.35,"body":"interesting times, Chris."},{"speaker":"Chris Dy","startTime":2083.59,"endTime":2086.59,"body":"Absolutely. Well, you"},{"speaker":"Chris Dy","startTime":2083.59,"endTime":2086.59,"body":"have a wonderful week. I'll see"},{"speaker":"Chris Dy","startTime":2086.59,"endTime":2087.19,"body":"you next time."},{"speaker":"Charles Goldfarb","startTime":2087.52,"endTime":2091.63,"body":"Thank you."},{"speaker":"Charles Goldfarb","startTime":2087.52,"endTime":2091.63,"body":"Hey, Chris, that was fun. Let's"},{"speaker":"Charles Goldfarb","startTime":2091.63,"endTime":2092.56,"body":"do it again real soon."},{"speaker":"Chris Dy","startTime":2092.83,"endTime":2095.35,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2092.83,"endTime":2095.35,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2095.56,"endTime":2097.81,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2095.56,"endTime":2097.81,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2098.11,"endTime":2100.96,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2098.11,"endTime":2100.96,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2101.11,"endTime":2104.59,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2101.11,"endTime":2104.59,"body":"spelled dy. If you'd like to"},{"speaker":"Chris Dy","startTime":2104.59,"endTime":2108.34,"body":"email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2104.59,"endTime":2108.34,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2108.91,"endTime":2111.07,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2108.91,"endTime":2111.07,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2111.07,"endTime":2112.12,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":2112.18,"endTime":2114.4,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2112.18,"endTime":2114.4,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2114.4,"endTime":2114.82,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2115.18,"endTime":2117.49,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2115.18,"endTime":2117.49,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2117.49,"endTime":2121.45,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2117.49,"endTime":2121.45,"body":"upper hand. Come back next time"}]}